[House Report 114-554]
[From the U.S. Government Publishing Office]
114th Congress } { Report
HOUSE OF REPRESENTATIVES
2d Session } { 114-554
======================================================================
IMPROVING TREATMENT FOR PREGNANT AND POSTPARTUM WOMEN ACT OF 2016
_______
May 10, 2016.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Upton, from the Committee on Energy and Commerce, submitted the
following
R E P O R T
[To accompany H.R. 3691]
[Including cost estimate of the Congressional Budget Office]
The Committee on Energy and Commerce, to whom was referred
the bill (H.R. 3691) to amend the Public Health Service Act to
reauthorize the residential treatment programs for pregnant and
postpartum women and to establish a pilot program to provide
grants to State substance abuse agencies to promote innovative
service delivery models for such women, having considered the
same, report favorably thereon with an amendment and recommend
that the bill as amended do pass.
CONTENTS
Page
Purpose and Summary.............................................. 3
Background and Need for Legislation.............................. 3
Hearings......................................................... 4
Committee Consideration.......................................... 4
Committee Votes.................................................. 4
Committee Oversight Findings..................................... 4
Statement of General Performance Goals and Objectives............ 4
New Budget Authority, Entitlement Authority, and Tax Expenditures 5
Earmark, Limited Tax Benefits, and Limited Tariff Benefits....... 5
Committee Cost Estimate.......................................... 5
Congressional Budget Office Estimate............................. 5
Federal Mandates Statement....................................... 7
Duplication of Federal Programs.................................. 7
Disclosure of Directed Rule Makings.............................. 7
Advisory Committee Statement..................................... 7
Applicability to Legislative Branch.............................. 7
Section-by-Section Analysis of the Legislation................... 7
Changes in Existing Law Made by the Bill, as Reported............ 8
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 ``Improving Treatment for Pregnant and
Postpartum Women Act of 2016''.
SEC. 2. REAUTHORIZATION OF RESIDENTIAL TREATMENT PROGRAMS FOR PREGNANT
AND POSTPARTUM WOMEN.
Section 508 of the Public Health Service Act (42 U.S.C. 290bb-1) is
amended--
(1) in subsection (p), in the first sentence, by inserting
``(other than subsection (r))'' after ``section''; and
(2) in subsection (r), by striking ``such sums'' and all that
follows through ``2003'' and inserting ``$16,900,000 for each
of fiscal years 2017 through 2021''.
SEC. 3. PILOT PROGRAM GRANTS FOR STATE SUBSTANCE ABUSE AGENCIES.
(a) In General.--Section 508 of the Public Health Service Act (42
U.S.C. 290bb-1) is amended--
(1) by redesignating subsection (r), as amended by section 2,
as subsection (s); and
(2) by inserting after subsection (q) the following new
subsection:
``(r) Pilot Program for State Substance Abuse Agencies.--
``(1) In general.--From amounts made available under
subsection (s), the Director of the Center for Substance Abuse
Treatment shall carry out a pilot program under which
competitive grants are made by the Director to State substance
abuse agencies to--
``(A) enhance flexibility in the use of funds
designed to support family-based services for pregnant
and postpartum women with a primary diagnosis of a
substance use disorder, including opioid use disorders;
``(B) help State substance abuse agencies address
identified gaps in services furnished to such women
along the continuum of care, including services
provided to women in nonresidential based settings; and
``(C) promote a coordinated, effective, and efficient
State system managed by State substance abuse agencies
by encouraging new approaches and models of service
delivery.
``(2) Requirements.--In carrying out the pilot program under
this subsection, the Director shall--
``(A) require State substance abuse agencies to
submit to the Director applications, in such form and
manner and containing such information as specified by
the Director, to be eligible to receive a grant under
the program;
``(B) identify, based on such submitted applications,
State substance abuse agencies that are eligible for
such grants;
``(C) require services proposed to be furnished
through such a grant to support family-based treatment
and other services for pregnant and postpartum women
with a primary diagnosis of a substance use disorder,
including opioid use disorders;
``(D) not require that services furnished through
such a grant be provided solely to women that reside in
facilities;
``(E) not require that grant recipients under the
program make available through use of the grant all
services described in subsection (d); and
``(F) consider not applying requirements described in
paragraphs (1) and (2) of subsection (f) to applicants,
depending on the circumstances of the applicant.
``(3) Required services.--
``(A) In general.--The Director shall specify a
minimum set of services required to be made available
to eligible women through a grant awarded under the
pilot program under this subsection. Such minimum set--
``(i) shall include requirements described in
subsection (c) and be based on the
recommendations submitted under subparagraph
(B); and
``(ii) may be selected from among the
services described in subsection (d) and
include other services as appropriate.
``(B) Stakeholder input.--The Director shall convene
and solicit recommendations from stakeholders,
including State substance abuse agencies, health care
providers, persons in recovery from substance abuse,
and other appropriate individuals, for the minimum set
of services described in subparagraph (A).
``(4) Duration.--The pilot program under this subsection
shall not exceed 5 years.
``(5) Evaluation and report to congress.--The Director of the
Center for Behavioral Health Statistics and Quality shall fund
an evaluation of the pilot program at the conclusion of the
first grant cycle funded by the pilot program. The Director of
the Center for Behavioral Health Statistics and Quality, in
coordination with the Director of the Center for Substance
Abuse Treatment shall submit to the relevant committees of
jurisdiction of the House of Representatives and the Senate a
report on such evaluation. The report shall include at a
minimum outcomes information from the pilot program, including
any resulting reductions in the use of alcohol and other drugs;
engagement in treatment services; retention in the appropriate
level and duration of services; increased access to the use of
medications approved by the Food and Drug Administration for
the treatment of substance use disorders in combination with
counseling; and other appropriate measures.
``(6) State substance abuse agencies defined.--For purposes
of this subsection, the term `State substance abuse agency'
means, with respect to a State, the agency in such State that
manages the Substance Abuse Prevention and Treatment Block
Grant under part B of title XIX.''.
(b) Funding.--Subsection (s) of section 508 of the Public Health
Service Act (42 U.S.C. 290bb-1), as amended by section 2 and
redesignated by subsection (a), is further amended by adding at the end
the following new sentence: ``Of the amounts made available for a year
pursuant to the previous sentence to carry out this section, not more
than 25 percent of such amounts shall be made available for such year
to carry out subsection (r), other than paragraph (5) of such
subsection. Notwithstanding the preceding sentence, no funds shall be
made available to carry out subsection (r) for a fiscal year unless the
amount made available to carry out this section for such fiscal year is
more than the amount made available to carry out this section for
fiscal year 2016.''.
SEC. 4. CUT-GO COMPLIANCE.
Subsection (f) of section 319D of the Public Health Service Act (42
U.S.C. 247d-4) is amended by striking ``through 2018'' and inserting
``through 2016, $133,300,000 for fiscal year 2017, and $138,300,000 for
fiscal year 2018''.
Purpose and Summary
H.R. 3691, the ``Improving Treatment for Pregnant and
Postpartum Women Act of 2016,'' was introduced by Rep. Ben Ray
Lujan (D-NM), Rep. Tonko (D-NY), Rep. Clarke (D-NY), Rep.
Matsui (D-CA), and Rep. Cardenas (D-CA). This legislation
reauthorizes a grant program for residential treatment for
pregnant and postpartum women who have an opioid use disorder
and for their children, including those who may be born with
neonatal abstinence syndrome. It creates a new pilot program to
enhance the flexibility of the funds so states can more broadly
support family-based services for pregnant and postpartum women
and their children.
Background and Need for Legislation
In most instances, withdrawal or detoxification is not
clinically appropriate for pregnant women with opioid use
disorders. The withdrawal symptoms associated with
discontinuing opioid use in pregnant women can lead to
miscarriage or other negative birth outcomes. Buprenorphine and
methadone can be used to treat a woman's opioid use disorder
while pregnant. Such treatment can result in improved outcomes
for both mothers and babies.
Unfortunately, babies exposed to opioids in utero may be
born with neonatal abstinence syndrome (NAS), which refers to
medical issues associated with opioid withdrawal in newborns.
Mothers suffering from opioid use disorder may be sent home
with babies who have NAS with very little guidance or support
which can have negative consequences for their babies. In the
United States, the incidence of NAS has risen from 1.20 per
1,000 hospital births in 2000 to 3.9 per 1,000 hospital births
in 2009. NAS can result from the use of prescription opioids as
prescribed for medical reasons, abuse of prescription opioid
medication, or the use of illegal opioids like heroin.
The grant program reauthorized in Section 508 of the Public
Health Service Act helps support residential treatment
facilities where women and their children receive support,
education, treatment, and counseling that they need. The pilot
program will allow states more flexibility in providing these
services for women and children in need.
Hearings
The Subcommittee on Health held a hearing on H.R. 3391 on
October 20, 2015. The Subcommittee received testimony from:
Mr. Michael Botticelli, Director, National
Drug Control Policy, Executive Office of the President;
Dr. Richard Frank, Assistant Secretary for
Planning and Evaluation, Department of Health and Human
Services;
Mr. Jack Riley, Deputy Administrator, Drug
Enforcement Administration;
Dr. Allen Anderson, President, American
Orthopaedic Society for Sports Medicine;
Dr. Paul Halverson, Dean, Indiana University,
Richard M. Fairbanks School of Public Health;
Dr. Kenneth Katz, Lehigh Valley Health
Network, Department of Emergency Medicine, Section of
Medical Toxicology;
Dr. Chapman Sledge, Chief Medical Officer,
Cumberland Heights; and,
Dr. Robert Corey Waller, Chair, Legislative
Advocacy Committee, American Society of Addiction
Medicine.
Committee Consideration
On April 20, 2016, the Subcommittee on health met in open
markup session and forwarded H.R. 3691, without amendment, to
the full Committee by a voice vote. On April 26, 27, and 28,
2016, the full Committee on Energy and Commerce met in open
markup session and ordered H.R. 3691 reported to the House, as
amended, by a voice vote.
Committee Votes
Clause 3(b) of rule XIII of the Rules of the House of
Representatives requires the Committee to list the record votes
on the motion to report legislation and amendments thereto.
There were no record votes taken in connection with ordering
H.R. 3691 reported.
Committee Oversight Findings
Pursuant to clause 3(c)(1) of rule XIII of the Rules of the
House of Representatives, the Committee held a hearing and made
findings that are reflected in this report.
Statement of General Performance Goals and Objectives
The goal of this legislation is to reauthorize the
residential treatment programs for pregnant and postpartum
women and to establish a pilot program to provide grants to
state substance abuse agencies to promote innovative service
delivery models for such women.
New Budget Authority, Entitlement Authority, and Tax Expenditures
In compliance with clause 3(c)(2) of rule XIII of the Rules
of the House of Representatives, the Committee finds that H.R.
3691 would result in no new or increased budget authority,
entitlement authority, or tax expenditures or revenues.
Earmark, Limited Tax Benefits, and Limited Tariff Benefits
In compliance with clause 9(e), 9(f), and 9(g) of rule XXI
of the Rules of the House of Representatives, the Committee
finds that H.R. 3691 contains no earmarks, limited tax
benefits, or limited tariff benefits.
Committee Cost Estimate
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.
Congressional Budget Office Estimate
Pursuant to clause 3(c)(3) of rule XIII of the Rules of the
House of Representatives, the following is the cost estimate
provided by the Congressional Budget Office pursuant to section
402 of the Congressional Budget Act of 1974:
May 9, 2016.
Hon. Fred Upton,
Chairman, Committee on Energy and Commerce,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 3691, the
Improving Treatment for Pregnant and Postpartum Women Act of
2015.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Ellen Werble.
Sincerely,
Keith Hall.
Enclosure.
H.R. 3691--Improving Treatment for Pregnant and Postpartum Women Act of
2015
Summary: H.R. 3691 would reauthorize programs for
residential treatment of pregnant and postpartum women. The
bill also would require the Substance Abuse and Mental Health
Services Administration (SAMHSA) to establish a pilot program
to award grants to support programs that treat substance abuse
in pregnant and postpartum women. Additionally, H.R. 3691 would
reduce amounts authorized to be appropriated for existing
activities related to bioterrorism and public health
emergencies at the Centers for Disease Control and Prevention
(CDC). Assuming appropriation actions consistent with the bill,
CBO estimates that implementing H.R. 3691 would have a net
discretionary cost of $65 million over the 2017-2021 period.
Pay-as-you-go procedures do not apply because enacting H.R.
3691 would not affect direct spending or revenues. CBO
estimates that enacting H.R. 3691 would not increase net direct
spending or on-budget deficits in any of the four consecutive
10-year periods beginning in 2027
H.R. 3691 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act (UMRA).
Estimated cost to the Federal Government: The estimated
budgetary effect of H.R. 3691 is shown in the following table.
The costs of this legislation fall within budget function 550
(health).
----------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
-------------------------------------------------------
2017 2018 2019 2020 2021 2017-2021
----------------------------------------------------------------------------------------------------------------
CHANGES IN SPENDING SUBJECT TO APPROPRIATION
Substance Abuse and Mental Health Services
Administration:
Authorization Level................................. 17 17 17 17 17 85
Estimated Outlays................................... 5 14 16 17 17 69
Centers for Disease Control and Prevention:
Authorization Level................................. -5 0 0 0 0 -5
Estimated Outlays................................... -2 -2 -1 * * -5
Total Changes:
Authorization Level............................. 12 17 17 17 17 80
Estimated Outlays............................... 4 12 16 17 17 65
----------------------------------------------------------------------------------------------------------------
Notes: * = between $0 and -$500,000; details may not add to totals because of rounding.
Basis of estimate: For this estimate, CB0 assumes that H.R.
3691 will be enacted near the end of fiscal year 2016 and that
spending will follow historical patterns for similar programs.
Substance abuse and mental health services administration
H.R. 3691 would reauthorize grants for residential
treatment programs for pregnant and postpartum women. The
authority for those grant programs at SAMHSA expired in 2003;
however, the Congress has continued to appropriate funds each
year. For fiscal year 2016, SAMHSA received an appropriation of
$15.9 million for those programs. The bill also would require
SAMHSA to establish a pilot program to award grants to support
programs to treat substance abuse in pregnant and postpartum
women and to fund an evaluation of the pilot program. The bill
would authorize the appropriation of $16.9 million for these
activities for each of fiscal years 2017 through 2021. Assuming
appropriation of the specified amounts, CB0 estimates that
implementing these provisions would cost about $69 million over
the 2017-2021 period.
Centers for Disease Control and Prevention
Under current law, an authorization of appropriation of
$138 million exists for 2017 for CDC activities related to
bioterrorism and public health emergencies. H.R. 3691 would
reduce the amount authorized by $5 million in 2017. Assuming
appropriations are reduced accordingly, CBO estimates that
implementing this provision would result in $5 million less in
discretionary outlays for those activities over 2017-2021
period.
Pay-as-you-go considerations: None.
Increase in long-term direct spending and deficits: CBO
estimates that enacting H.R. 3691 would not increase net direct
spending or on-budget deficits in any of the four consecutive
10-year periods beginning in 2027.
Intergovernmental and private-sector impact: H.R. 3691
contains no intergovernmental or private-sector mandates as
defined in UMRA. Any costs incurred by states or local
governments that apply for grants authorized by the bill would
be incurred voluntarily as a condition of federal assistance.
Estimate prepared by: Federal Costs: Ellen Werble; Impact
on State, Local, and Tribal Governments: Leo Lexi; Impact on
the Private Sector: Amy Petz.
Estimate approved by: Holly Harvey, Deputy Assistant
Director for Budget Analysis.
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.
Duplication of Federal Programs
No provision of H.R. 3691 establishes or reauthorizes a
program of the Federal Government known to be duplicative of
another Federal program, a program that was included in any
report from the Government Accountability Office to Congress
pursuant to section 21 of Public Law 111-139, or a program
related to a program identified in the most recent Catalog of
Federal Domestic Assistance.
Disclosure of Directed Rule Makings
The Committee estimates that enacting H.R. 3691
specifically directs to be completed 0 rule makings within the
meaning of 5 U.S.C. 551.
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 states that the legislation may be cited as the
``Improving Treatment for Pregnant and Postpartum Women Act of
2016.''
Section 2. Reauthorization of residential treatment programs for
pregnant and postpartum women
Section 2 reauthorizes Section 508 of the Public Health
Service Act, residential treatment programs for pregnant and
postpartum women. Section 508 is reauthorized for fiscal years
2017 to 2021 for $16.9 million a year over those five years.
Section 3. Pilot program grants for state substance abuse agencies
Section 3 creates a pilot program under Section 508 of the
Public Health Service Act to enhance flexibility in the use of
funds to support family-based services for pregnant and
postpartum women with a primary diagnosis of substance use
disorder, including opioid use disorder, and help states
identify gaps in service. This grant will also help promote
coordinated, effective and efficient state systems.
Section 4. Cut-Go compliance
Section 4 reduces the authorization of Section 319D of the
Public Health Service Act by $5,000,000 for fiscal year 2018 to
bring the legislation into compliance with Cut-Go. This
reduction is equal to the increase in authorization of
appropriations above the last appropriated level for the
program being reauthorized in Section 2 of H.R. 3691.
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italic, and existing law in which no
change is proposed is shown in roman):
PUBLIC HEALTH SERVICE ACT
* * * * * * *
TITLE III--GENERAL POWERS AND DUTIES OF PUBLIC HEALTH SERVICE
* * * * * * *
Part B--Federal-State Cooperation
* * * * * * *
SEC. 319D. REVITALIZING THE CENTERS FOR DISEASE CONTROL AND PREVENTION.
(a) Facilities; Capacities.--
(1) Findings.--Congress finds that the Centers for
Disease Control and Prevention has an essential role in
defending against and combatting public health threats
domestically and abroad and requires secure and modern
facilities, and expanded and improved capabilities
related to bioterrorism and other public health
emergencies, sufficient to enable such Centers to
conduct this important mission.
(2) Facilities.--
(A) In general.--The Director of the Centers
for Disease Control and Prevention may design,
construct, and equip new facilities, renovate
existing facilities (including laboratories,
laboratory support buildings, scientific
communication facilities, transshipment
complexes, secured and isolated parking
structures, office buildings, and other
facilities and infrastructure), and upgrade
security of such facilities, in order to better
conduct the capacities described in section
319A, and for supporting public health
activities.
(B) Multiyear contracting authority.--For any
project of designing, constructing, equipping,
or renovating any facility under subparagraph
(A), the Director of the Centers for Disease
Control and Prevention may enter into a single
contract or related contracts that collectively
include the full scope of the project, and the
solicitation and contract shall contain the
clause ``availability of funds'' found at
section 52.232-18 of title 48, Code of Federal
Regulations.
(3) Improving the capacities of the centers for
disease control and prevention.--The Secretary shall
expand, enhance, and improve the capabilities of the
Centers for Disease Control and Prevention relating to
preparedness for and responding effectively to
bioterrorism and other public health emergencies.
Activities that may be carried out under the preceding
sentence include--
(A) expanding or enhancing the training of
personnel;
(B) improving communications facilities and
networks, including delivery of necessary
information to rural areas;
(C) improving capabilities for public health
surveillance and reporting activities, taking
into account the integrated system or systems
of public health alert communications and
surveillance networks under subsection (b); and
(D) improving laboratory facilities related
to bioterrorism and other public health
emergencies, including increasing the security
of such facilities.
(b) National Communications and Surveillance Networks.--
(1) In general.--The Secretary, directly or through
awards of grants, contracts, or cooperative agreements,
shall provide for the establishment of an integrated
system or systems of public health alert communications
and surveillance networks between and among--
(A) Federal, State, and local public health
officials;
(B) public and private health-related
laboratories, hospitals, poison control
centers, and other health care facilities; and
(C) any other entities determined appropriate
by the Secretary.
(2) Requirements.--The Secretary shall ensure that
networks under paragraph (1) allow for the timely
sharing and discussion, in a secure manner, of
essential information concerning bioterrorism or
another public health emergency, or recommended methods
for responding to such an attack or emergency, allowing
for coordination to maximize all-hazards medical and
public health preparedness and response and to minimize
duplication of effort.
(3) Standards.--Not later than one year after the
date of the enactment of the Public Health Security and
Bioterrorism Preparedness and Response Act of 2002, the
Secretary, in cooperation with health care providers
and State and local public health officials, shall
establish any additional technical and reporting
standards (including standards for interoperability)
for networks under paragraph (1) and update such
standards as necessary.
(c) Modernizing Public Health Situational Awareness and
Biosurveillance.--
(1) In general.--Not later than 2 years after the
date of enactment of the Pandemic and All-Hazards
Preparedness Reauthorization Act of 2013, the
Secretary, in collaboration with State, local, and
tribal public health officials, shall establish a near
real-time electronic nationwide public health
situational awareness capability through an
interoperable network of systems to share data and
information to enhance early detection of rapid
response to, and management of, potentially
catastrophic infectious disease outbreaks, novel
emerging threats, and other public health emergencies
that originate domestically or abroad. Such network
shall be built on existing State situational awareness
systems or enhanced systems that enable such
connectivity.
(2) Strategy and implementation plan.--Not later than
180 days after the date of enactment of the Pandemic
and All-Hazards Preparedness Reauthorization Act of
2013, the Secretary shall submit to the appropriate
committees of Congress a coordinated strategy and an
accompanying implementation plan that identifies and
demonstrates the measurable steps the Secretary will
carry out to--
(A) develop, implement, and evaluate the
network described in paragraph (1), utilizing
the elements described in paragraph (3);
(B) modernize and enhance biosurveillance
activities; and
(C) improve information sharing,
coordination, and communication among disparate
biosurveillance systems supported by the
Department of Health and Human Services.
(3) Elements.--The network described in paragraph (1)
shall include data and information transmitted in a
standardized format from--
(A) State, local, and tribal public health
entities, including public health laboratories;
(B) Federal health agencies;
(C) zoonotic disease monitoring systems;
(D) public and private sector health care
entities, hospitals, pharmacies, poison control
centers or professional organizations in the
field of poison control, community health
centers, health centers and clinical
laboratories, to the extent practicable and
provided that such data are voluntarily
provided simultaneously to the Secretary and
appropriate State, local, and tribal public
health agencies; and
(E) such other sources as the Secretary may
deem appropriate.
(4) Rule of construction.--Paragraph (3) shall not be
construed as requiring separate reporting of data and
information from each source listed.
(5) Required activities.--In establishing and
operating the network described in paragraph (1), the
Secretary shall--
(A) utilize applicable interoperability
standards as determined by the Secretary, and
in consultation with the Office of the National
Coordinator for Health Information Technology,
through a joint public and private sector
process;
(B) define minimal data elements for such
network;
(C) in collaboration with State, local, and
tribal public health officials, integrate and
build upon existing State, local, and tribal
capabilities, ensuring simultaneous sharing of
data, information, and analyses from the
network described in paragraph (1) with State,
local, and tribal public health agencies; and
(D) in collaboration with State, local, and
tribal public health officials, develop
procedures and standards for the collection,
analysis, and interpretation of data that
States, regions, or other entities collect and
report to the network described in paragraph
(1).
(6) Consultation with the national biodefense science
board.--In carrying out this section and consistent
with section 319M, the National Biodefense Science
Board shall provide expert advice and guidance,
including recommendations, regarding the measurable
steps the Secretary should take to modernize and
enhance biosurveillance activities pursuant to the
efforts of the Department of Health and Human Services
to ensure comprehensive, real-time, all-hazards
biosurveillance capabilities. In complying with the
preceding sentence, the National Biodefense Science
Board shall--
(A) identify the steps necessary to achieve a
national biosurveillance system for human
health, with international connectivity, where
appropriate, that is predicated on State,
regional, and community level capabilities and
creates a networked system to allow for two-way
information flow between and among Federal,
State, and local government public health
authorities and clinical health care providers;
(B) identify any duplicative surveillance
programs under the authority of the Secretary,
or changes that are necessary to existing
programs, in order to enhance and modernize
such activities, minimize duplication,
strengthen and streamline such activities under
the authority of the Secretary, and achieve
real-time and appropriate data that relate to
disease activity, both human and zoonotic; and
(C) coordinate with applicable existing
advisory committees of the Director of the
Centers for Disease Control and Prevention,
including such advisory committees consisting
of representatives from State, local, and
tribal public health authorities and
appropriate public and private sector health
care entities and academic institutions, in
order to provide guidance on public health
surveillance activities.
(d) State and Regional Systems To Enhance Situational
Awareness in Public Health Emergencies.--
(1) In general.--To implement the network described
in subsection (c), the Secretary may award grants to
States or consortia of States to enhance the ability of
such States or consortia of States to establish or
operate a coordinated public health situational
awareness system for regional or Statewide early
detection of, rapid response to, and management of
potentially catastrophic infectious disease outbreaks
and public health emergencies, in collaboration with
appropriate public health agencies, sentinel hospitals,
clinical laboratories, pharmacies, poison control
centers, other health care organizations, and animal
health organizations within such States.
(2) Eligibility.--To be eligible to receive a grant
under paragraph (1), the State or consortium of States
shall submit to the Secretary an application at such
time, in such manner, and containing such information
as the Secretary may require, including an assurance
that the State or consortium of States will submit to
the Secretary--
(A) reports of such data, information, and
metrics as the Secretary may require;
(B) a report on the effectiveness of the
systems funded under the grant; and
(C) a description of the manner in which
grant funds will be used to enhance the
timelines and comprehensiveness of efforts to
detect, respond to, and manage potentially
catastrophic infectious disease outbreaks and
public health emergencies.
(3) Use of funds.--A State or consortium of States
that receives an award under this subsection--
(A) shall establish, enhance, or operate a
coordinated public health situational awareness
system for regional or Statewide early
detection of, rapid response to, and management
of potentially catastrophic infectious disease
outbreaks and public health emergencies;
(B) may award grants or contracts to entities
described in paragraph (1) within or serving
such State to assist such entities in improving
the operation of information technology
systems, facilitating the secure exchange of
data and information, and training personnel to
enhance the operation of the system described
in subparagraph (A); and
(C) may conduct a pilot program for the
development of multi-State telehealth network
test beds that build on, enhance, and securely
link existing State and local telehealth
programs to prepare for, monitor, respond to,
and manage the events of public health
emergencies, facilitate coordination and
communication among medical, public health, and
emergency response agencies, and provide
medical services through telehealth initiatives
within the States that are involved in such a
multi-State telehealth network test bed.
(4) Limitation.--Information technology systems
acquired or implemented using grants awarded under this
section must be compliant with--
(A) interoperability and other technological
standards, as determined by the Secretary; and
(B) data collection and reporting
requirements for the network described in
subsection (c).
(5) Independent evaluation.--Not later than 3 years
after the date of enactment of the Pandemic and All-
Hazards Preparedness Reauthorization Act of 2013, the
Government Accountability Office shall conduct an
independent evaluation, and submit to the Secretary and
the appropriate committees of Congress a report
concerning the activities conducted under this
subsection and subsection (c).
(e) Telehealth Enhancements for Emergency Response.--
(1) Evaluation.--The Secretary, in consultation with
the Federal Communications Commission and other
relevant Federal agencies, shall--
(A) conduct an inventory of telehealth
initiatives in existence on the date of
enactment of the Pandemic and All-Hazards
Preparedness Act, including--
(i) the specific location of network
components;
(ii) the medical, technological, and
communications capabilities of such
components;
(iii) the functionality of such
components; and
(iv) the capacity and ability of such
components to handle increased volume
during the response to a public health
emergency;
(B) identify methods to expand and
interconnect the regional health information
networks funded by the Secretary, the State and
regional broadband networks funded through the
rural health care support mechanism pilot
program funded by the Federal Communications
Commission, and other telehealth networks;
(C) evaluate ways to prepare for, monitor,
respond rapidly to, or manage the events of, a
public health emergency through the enhanced
use of telehealth technologies, including
mechanisms for payment or reimbursement for use
of such technologies and personnel during
public health emergencies;
(D) identify methods for reducing legal
barriers that deter health care professionals
from providing telemedicine services, such as
by utilizing State emergency health care
professional credentialing verification
systems, encouraging States to establish and
implement mechanisms to improve interstate
medical licensure cooperation, facilitating the
exchange of information among States regarding
investigations and adverse actions, and
encouraging States to waive the application of
licensing requirements during a public health
emergency;
(E) evaluate ways to integrate the practice
of telemedicine within the National Disaster
Medical System; and
(F) promote greater coordination among
existing Federal interagency telemedicine and
health information technology initiatives.
(2) Report.--Not later than 12 months after the date
of enactment of the Pandemic and All-Hazards
Preparedness Act, the Secretary shall prepare and
submit a report to the Committee on Health, Education,
Labor, and Pensions of the Senate and the Committee on
Energy and Commerce of the House of Representatives
regarding the findings and recommendations pursuant to
subparagraphs (A) through (F) of paragraph (1).
(f) Authorization of Appropriations.--There are authorized to
be appropriated to carry out this section, $138,300,000 for
each of fiscal years 2014 [through 2018] through 2016,
$133,300,000 for fiscal year 2017, and $138,300,000 for fiscal
year 2018.
(g) Definition.--For purposes of this section the term
``biosurveillance'' means the process of gathering near real-
time biological data that relates to human and zoonotic disease
activity and threats to human or animal health, in order to
achieve early warning and identification of such health
threats, early detection and prompt ongoing tracking of health
events, and overall situational awareness of disease activity.
* * * * * * *
TITLE V--SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION
* * * * * * *
Part B--Centers and Programs
Subpart 1--Center for Substance Abuse Treatment
* * * * * * *
residential treatment programs for pregnant and postpartum women
Sec. 508. (a) In General.--The Director of the Center for
Substance Abuse Treatment shall provide awards of grants,
cooperative agreement, or contracts to public and nonprofit
private entities for the purpose of providing to pregnant and
postpartum women treatment for substance abuse through programs
in which, during the course of receiving treatment--
(1) the women reside in facilities provided by the
programs;
(2) the minor children of the women reside with the
women in such facilities, if the women so request; and
(3) the services described in subsection (d) are
available to or on behalf of the women.
(b) Availability of Services for Each Participant.--A funding
agreement for an award under subsection (a) for an applicant is
that, in the program operated pursuant to such subsection--
(1) treatment services and each supplemental service
will be available through the applicant, either
directly or through agreements with other public or
nonprofit private entities; and
(2) the services will be made available to each woman
admitted to the program.
(c) Individualized Plan of Services.--A funding agreement for
an award under subsection (a) for an applicant is that--
(1) in providing authorized services for an eligible
woman pursuant to such subsection, the applicant will,
in consultation with the women, prepare an
individualized plan for the provision to the woman of
the services; and
(2) treatment services under the plan will include--
(A) individual, group, and family counseling,
as appropriate, regarding substance abuse; and
(B) follow-up services to assist the woman in
preventing a relapse into such abuse.
(d) Required Supplemental Services.--In the case of an
eligible woman, the services referred to in subsection (a)(3)
are as follows:
(1) Prenatal and postpartum health care.
(2) Referrals for necessary hospital services.
(3) For the infants and children of the woman--
(A) pediatric health care, including
treatment for any perinatal effects of maternal
substance abuse and including screenings
regarding the physical and mental development
of the infants and children;
(B) counseling and other mental health
services, in the case of children; and
(C) comprehensive social services.
(4) Providing supervision of children during periods
in which the woman is engaged in therapy or in other
necessary health or rehabilitative activities.
(5) Training in parenting.
(6) Counseling on the human immunodeficiency virus
and on acquired immune deficiency syndrome.
(7) Counseling on domestic violence and sexual abuse.
(8) Counseling on obtaining employment, including the
importance of graduating from a secondary school.
(9) Reasonable efforts to preserve and support the
family units of the women, including promoting the
appropriate involvement of parents and others, and
counseling the children of the women.
(10) Planning for and counseling to assist reentry
into society, both before and after discharge,
including referrals to any public or nonprofit private
entities in the community involved that provide
services appropriate for the women and the children of
the women.
(11) Case management services, including--
(A) assessing the extent to which authorized
services are appropriate for the women and
their children;
(B) in the case of the services that are
appropriate, ensuring that the services are
provided in a coordinated manner; and
(C) assistance in establishing eligibility
for assistance under Federal, State, and local
programs providing health services, mental
health services, housing services, employment
services, educational services, or social
services.
(e) Minimum Qualifications For Receipt of Award.--
(1) Certification by relevant state agency.--With
respect to the principal agency of the State involved
that administers programs relating to substance abuse,
the Director may make an award under subsection (a) to
an applicant only if the agency has certified to the
Director that--
(A) the applicant has the capacity to carry
out a program described in subsection (a);
(B) the plans of the applicant for such a
program are consistent with the policies of
such agency regarding the treatment of
substance abuse; and
(C) the applicant, or any entity through
which the applicant will provide authorized
services, meets all applicable State licensure
or certification requirements regarding the
provision of the services involved.
(2) Status as medicaid provider.--
(A) Subject to subparagraphs (B) and (C), the
Director may make an award under subsection (a)
only if, in the case of any authorized service
that is available pursuant to the State plan
approved under title XIX of the Social Security
Act for the State involved--
(i) the applicant for the award will
provide the service directly, and the
applicant has entered into a
participation agreement under the State
plan and is qualified to receive
payments under such plan; or
(ii) the applicant will enter into an
agreement with a public or nonprofit
private entity under which the entity
will provide the service, and the
entity has entered into such a
participation agreement plan and is
qualified to receive such payments.
(B)(i) In the case of an entity making an
agreement pursuant to subparagraph (A)(ii)
regarding the provision of services, the
requirement established in such subparagraph
regarding a participation agreement shall be
waived by the Director if the entity does not,
in providing health care services, impose a
charge or accept reimbursement available from
any third-party payor, including reimbursement
under any insurance policy or under any Federal
or State health benefits plan.
(ii) A determination by the Director of
whether an entity referred to in clause (i)
meets the criteria for a waiver under such
clause shall be made without regard to whether
the entity accepts voluntary donations
regarding the provision of services to the
public.
(C) With respect to any authorized service
that is available pursuant to the State plan
described in subparagraph (A), the requirements
established in such subparagraph shall not
apply to the provision of any such service by
an institution for mental diseases to an
individual who has attained 21 years of age and
who has not attained 65 years of age. For
purposes of the preceding sentence, the term
``institution for mental diseases'' has the
meaning given such term in section 1905(i) of
the Social Security Act.
(f) Requirement of Matching Funds.--
(1) In general.--With respect to the costs of the
program to be carried out by an applicant pursuant to
subsection (a), a funding agreement for an award under
such subsection is that the applicant will make
available (directly or through donations from public or
private entities) non-Federal contributions toward such
costs in an amount that--
(A) for the first fiscal year for which the
applicant receives payments under an award
under such subsection, is not less than $1 for
each $9 of Federal funds provided in the award;
(B) for any second such fiscal year, is not
less than $1 for each $9 of Federal funds
provided in the award; and
(C) for any subsequent such fiscal year, is
not less than $1 for each $3 of Federal funds
provided in the award.
(2) Determination of amount contributed.--Non-Federal
contributions required in paragraph (1) may be in cash
or in kind, fairly evaluated, including plant,
equipment, or services. Amounts provided by the Federal
Government, or services assisted or subsidized to any
significant extent by the Federal Government, may not
be included in determining the amount of such non-
Federal contributions.
(g) Outreach.--A funding agreement for an award under
subsection (a) for an applicant is that the applicant will
provide outreach services in the community involved to identify
women who are engaging in substance abuse and to encourage the
women to undergo treatment for such abuse.
(h) Accessibility of Program; Cultural Context of Services.--
A funding agreement for an award under subsection (a) for an
applicant is that--
(1) the program operated pursuant to such subsection
will be operated at a location that is accessible to
low-income pregnant and postpartum women; and
(2) authorized services will be provided in the
language and the cultural context that is most
appropriate.
(i) Continuing Education.--A funding agreement for an award
under subsection (a) is that the applicant involved will
provide for continuing education in treatment services for the
individuals who will provide treatment in the program to be
operated by the applicant pursuant to such subsection.
(j) Imposition of Charges.--A funding agreement for an award
under subsection (a) for an applicant is that, if a charge is
imposed for the provision of authorized services to on behalf
of an eligible woman, such charge--
(1) will be made according to a schedule of charges
that is made available to the public;
(2) will be adjusted to reflect the income of the
woman involved; and
(3) will not be imposed on any such woman with an
income of less than 185 percent of the official poverty
line, as established by the Director of the Office for
Management and Budget and revised by the Secretary in
accordance with section 673(2) of the Omnibus Budget
Reconciliation Act of 1981.
(k) Reports to Director.--A funding agreement for an award
under subsection (a) is that the applicant involved will submit
to the Director a report--
(1) describing the utilization and costs of services
provided under the award;
(2) specifying the number of women served, the number
of infants served, and the type and costs of services
provided; and
(3) providing such other information as the Director
determines to be appropriate.
(l) Requirement of Application.--The Director may make an
award under subsection (a) only if an application for the award
is submitted to the Director containing such agreements, and
the application is in such form, is made in such manner, and
contains such other agreements and such assurances and
information as the Director determines to be necessary to carry
out this section.
(m) Equitable Allocation of Awards.--In making awards under
subsection (a), the Director shall ensure that the awards are
equitably allocated among the principal geographic regions of
the United States, subject to the availability of qualified
applicants for the awards.
(n) Duration of Award.--The period during which payments are
made to an entity from an award under subsection (a) may not
exceed 5 years. The provision of such payments shall be subject
to annual approval by the Director of the payments and subject
to the availability of appropriations for the fiscal year
involved to make the payments. This subsection may not be
construed to establish a limitation on the number of awards
under such subsection that may be made to an entity.
(o) Evaluations; Dissemination of Findings.--The Director
shall, directly or through contract, provide for the conduct of
evaluations of programs carried out pursuant to subsection (a).
The Director shall disseminate to the States the findings made
as a result of the evaluations.
(p) Reports to Congress.--Not later than October 1, 1994, the
Director shall submit to the Committee on Energy and Commerce
of the House of Representatives, and to the Committee on Labor
and Human Resources of the Senate, a report describing programs
carried out pursuant to this section (other than subsection
(r)). Every 2 years thereafter, the Director shall prepare a
report describing such programs carried out during the
preceding 2 years, and shall submit the report to the
Administrator for inclusion in the biennial report under
section 501(k). Each report under this subsection shall include
a summary of any evaluations conducted under subsection (m)
during the period with respect to which the report is prepared.
(q) Definitions.--For purposes of this section:
(1) The term ``authorized services'' means treatment
services and supplemental services.
(2) The term ``eligible woman'' means a woman who has
been admitted to a program operated pursuant to
subsection (a).
(3) The term ``funding agreement under subsection
(a)'', with respect to an award under subsection (a),
means that the Director may make the award only if the
applicant makes the agreement involved.
(4) The term ``treatment services'' means treatment
for substance abuse, including the counseling and
services described in subsection (c)(2).
(5) The term ``supplemental services'' means the
services described in subsection (d).
(r) Pilot Program for State Substance Abuse Agencies.--
(1) In general.--From amounts made available under
subsection (s), the Director of the Center for
Substance Abuse Treatment shall carry out a pilot
program under which competitive grants are made by the
Director to State substance abuse agencies to--
(A) enhance flexibility in the use of funds
designed to support family-based services for
pregnant and postpartum women with a primary
diagnosis of a substance use disorder,
including opioid use disorders;
(B) help State substance abuse agencies
address identified gaps in services furnished
to such women along the continuum of care,
including services provided to women in
nonresidential based settings; and
(C) promote a coordinated, effective, and
efficient State system managed by State
substance abuse agencies by encouraging new
approaches and models of service delivery.
(2) Requirements.--In carrying out the pilot program
under this subsection, the Director shall--
(A) require State substance abuse agencies to
submit to the Director applications, in such
form and manner and containing such information
as specified by the Director, to be eligible to
receive a grant under the program;
(B) identify, based on such submitted
applications, State substance abuse agencies
that are eligible for such grants;
(C) require services proposed to be furnished
through such a grant to support family-based
treatment and other services for pregnant and
postpartum women with a primary diagnosis of a
substance use disorder, including opioid use
disorders;
(D) not require that services furnished
through such a grant be provided solely to
women that reside in facilities;
(E) not require that grant recipients under
the program make available through use of the
grant all services described in subsection (d);
and
(F) consider not applying requirements
described in paragraphs (1) and (2) of
subsection (f) to applicants, depending on the
circumstances of the applicant.
(3) Required services.--
(A) In general.--The Director shall specify a
minimum set of services required to be made
available to eligible women through a grant
awarded under the pilot program under this
subsection. Such minimum set--
(i) shall include requirements
described in subsection (c) and be
based on the recommendations submitted
under subparagraph (B); and
(ii) may be selected from among the
services described in subsection (d)
and include other services as
appropriate.
(B) Stakeholder input.--The Director shall
convene and solicit recommendations from
stakeholders, including State substance abuse
agencies, health care providers, persons in
recovery from substance abuse, and other
appropriate individuals, for the minimum set of
services described in subparagraph (A).
(4) Duration.--The pilot program under this
subsection shall not exceed 5 years.
(5) Evaluation and report to congress.--The Director
of the Center for Behavioral Health Statistics and
Quality shall fund an evaluation of the pilot program
at the conclusion of the first grant cycle funded by
the pilot program. The Director of the Center for
Behavioral Health Statistics and Quality, in
coordination with the Director of the Center for
Substance Abuse Treatment shall submit to the relevant
committees of jurisdiction of the House of
Representatives and the Senate a report on such
evaluation. The report shall include at a minimum
outcomes information from the pilot program, including
any resulting reductions in the use of alcohol and
other drugs; engagement in treatment services;
retention in the appropriate level and duration of
services; increased access to the use of medications
approved by the Food and Drug Administration for the
treatment of substance use disorders in combination
with counseling; and other appropriate measures.
(6) State substance abuse agencies defined.--For
purposes of this subsection, the term ``State substance
abuse agency'' means, with respect to a State, the
agency in such State that manages the Substance Abuse
Prevention and Treatment Block Grant under part B of
title XIX.
[(r)] (s) Authorization of Appropriations.--For the purpose
of carrying out this section, there are authorized to be
appropriated [such sums as may be necessary to fiscal years
2001 through 2003] $16,900,000 for each of fiscal years 2017
through 2021. Of the amounts made available for a year pursuant
to the previous sentence to carry out this section, not more
than 25 percent of such amounts shall be made available for
such year to carry out subsection (r), other than paragraph (5)
of such subsection. Notwithstanding the preceding sentence, no
funds shall be made available to carry out subsection (r) for a
fiscal year unless the amount made available to carry out this
section for such fiscal year is more than the amount made
available to carry out this section for fiscal year 2016.
* * * * * * *