HR 3301 IH

To amend the Public Health Service Act with respect to children's health.

November 10, 1999

Mr. BILIRAKIS (for himself, Mr. BROWN of Ohio, Mrs. EMERSON, Mr. TOWNS, Mr. GREENWOOD, Mr. UPTON, Ms. DEGETTE, Mr. SMITH of New Jersey, Mr. WAXMAN, and Mr. WALSH) introduced the following bill; which was referred to the Committee on Commerce

To amend the Public Health Service Act with respect to children's health.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the `Children's Health Research and Prevention Amendments of 1999'.

SEC. 2. TABLE OF CONTENTS.

The table of contents for this Act is as follows:

Sec. 1. Short title.

Sec. 2. Table of contents.

TITLE I--REVISION AND EXTENSION OF PROGRAMS

Subtitle A--Pediatric Research Initiative

Sec. 101. Short title.

Sec. 102. Establishment of a pediatric research initiative.

Sec. 103. Investment in tomorrow's pediatric researchers.

Subtitle B--Other Programs

Sec. 111. Childhood immunizations.

Sec. 112. Screenings, referrals, and education regarding lead poisoning.

Sec. 113. Prevention and control of injuries; traumatic brain injury.

TITLE II--CHILDREN'S HEALTH RESEARCH AND PREVENTION ACTIVITIES

Subtitle A--Early Detection, Diagnosis, and Treatment Regarding Hearing Loss in Infants

Sec. 201. Short title.

Sec. 202. Early detection, diagnosis, and interventions for newborns and infants with hearing loss.

Subtitle B--Autism

Chapter 1--Surveillance and Research Regarding Prevalence and Pattern of Autism

Sec. 211. Short title.

Sec. 212. Developmental disabilities surveillance and research programs.

Sec. 213. Clearinghouse.

Sec. 214. Advisory committee.

Sec. 215. Report to Congress.

Sec. 216. Definition.

Sec. 217. Authorization of appropriations.

Chapter 2--Expansion, Intensification, and Coordination of Activities of Department of Health and Human Services With Respect to Autism

Sec. 218. Short title.

Sec. 218A. Expansion, intensification, and coordination of activities of National Institutes of Health.

Sec. 219. Developmental disabilities surveillance and research programs.

Sec. 220. Information and education.

Sec. 220A. Interagency autism coordinating committee.

Sec. 220B. Report to Congress.

Subtitle C--Poison Control Center Enhancement and Awareness

Sec. 221. Short title.

Sec. 222. Definition.

Sec. 223. Establishment of a national toll-free number.

Sec. 224. Establishment of nationwide media campaign.

Sec. 225. Establishment of a grant program.

Subtitle D--Birth Defects Prevention Activities

Chapter 1--Folic Acid Promotion

Sec. 231. Short title.

Sec. 232. Program regarding effects of folic acid in prevention of birth defects.

Chapter 2--National Center on Birth Defects and Developmental Disabilities

Sec. 236. National Center on Birth Defects and Developmental Disabilities.

Subtitle E--Safe Motherhood Monitoring and Prevention Research

Sec. 241. Short title.

Sec. 242. Amendment to Public Health Service Act.

Subtitle F--Pregnant Mothers and Infants Health Promotion

Sec. 251. Short title.

Sec. 252. Establishment.

Subtitle G--Utilization of Preventive Health Services

Sec. 261. Grants regarding utilization of preventive health services.

Subtitle H--Research and Development Regarding Fragile X

Sec. 266. Short title.

Sec. 267. National Institute of Child Health and Human Development; research on fragile X.

Sec. 268. National Institute of Child Health and Human Development; loan repayment program regarding research on fragile X.

Subtitle I--Children and Epilepsy

Sec. 271. Programs of the Centers for Disease Control and Prevention; national public health campaign on epilepsy.

Sec. 272. Programs of Health Resources and Services Administration; State and local grants for seizure disorder demonstration projects in medically underserved areas.

Sec. 273. Definitions.

Subtitle J--Asthma Treatment Services for Children

Sec. 276. Short title.

Sec. 277. Children's asthma relief.

Sec. 278. Incorporation of asthma prevention treatment and services into State children's health insurance programs.

Sec. 279. Preventive health and health services block grant; systems for reducing asthma and asthma-related illnesses through urban cockroach management.

Sec. 279A. Coordination of Federal activities to address asthma-related health care needs.

Sec. 279B. Compilation of data by the Centers for Disease Control and Prevention.

Subtitle K--Juvenile Arthritis and Related Conditions

Sec. 281. Research on juvenile arthritis and related conditions.

Subtitle L--Childhood Skeletal Malignancies

Sec. 286. Programs of Centers for Disease Control and Prevention.

Subtitle M--Reducing Burden of Diabetes Among Children and Youth

Sec. 291. Programs regarding diabetes in children and youth.

Subtitle N--Miscellaneous Provisions

Sec. 296. Report regarding research on rare diseases in children.

TITLE I--REVISION AND EXTENSION OF PROGRAMS

Subtitle A--Pediatric Research Initiative

SEC. 101. SHORT TITLE.

This subtitle may be cited as the `Pediatric Research Initiative Act of 1999'.

SEC. 102. ESTABLISHMENT OF A PEDIATRIC RESEARCH INITIATIVE.

Part A of title IV of the Public Health Service Act (42 U.S.C. 281 et seq.) is amended by adding at the end the following:

`SEC. 404F. PEDIATRIC RESEARCH INITIATIVE.

`(a) ESTABLISHMENT- The Secretary shall establish within the Office of the Director of NIH a Pediatric Research Initiative (referred to in this section as the `Initiative'). The Initiative shall be headed by the Director of NIH.

`(b) PURPOSE- The purpose of the Initiative is to provide funds to enable the Director of NIH to encourage--

`(1) increased support for pediatric biomedical research within the National Institutes of Health to ensure that the expanding opportunities for advancement in scientific investigations and care for children are realized;

`(2) enhanced collaborative efforts among the Institutes to support multidisciplinary research in the areas that the Director deems most promising; and

`(3) the development of adequate pediatric clinical trials and pediatric use information to promote the safer and more effective use of prescription drugs in the pediatric population.

`(c) DUTIES- In carrying out subsection (b), the Director of NIH shall--

`(1) consult with the Institute of Child Health and Human Development and the other Institutes, in considering their requests for new or expanded pediatric research efforts, and consult with other advisors as the Director determines appropriate;

`(2) have broad discretion in the allocation of any Initiative assistance among the Institutes, among types of grants, and between basic and clinical research so long as the--

`(A) assistance is directly related to the illnesses and conditions of children; and

`(B) assistance is extramural in nature; and

`(3) be responsible for the oversight of any newly appropriated Initiative funds and annually report to Congress and the public on the extent of the total extramural support for pediatric research across the NIH, including the specific support and research awards allocated through the Initiative.

`(d) AUTHORIZATION- For the purpose of carrying out this section, there are authorized to be appropriated such sums as may be necessary for each of the fiscal years 2000 through 2003.

`(e) TRANSFER OF FUNDS- The Director of NIH may transfer amounts appropriated under this section to any of the Institutes for a fiscal year to carry out the purposes of the Initiative under this section.'.

SEC. 103. INVESTMENT IN TOMORROW'S PEDIATRIC RESEARCHERS.

Subpart 7 of part C of title IV of the Public Health Service Act (42 U.S.C. 285g et seq.) is amended by adding at the end the following:

`SEC. 452E. INVESTMENT IN TOMORROW'S PEDIATRIC RESEARCHERS.

`(a) IN GENERAL- The Secretary shall make available within the National Institute of Child Health and Human Development enhanced support for extramural activities relating to the training and career development of pediatric researchers.

`(b) PURPOSE- The purpose of support provided under subsection (a) shall be to ensure the future supply of researchers dedicated to the care and research needs of children by providing for--

`(1) an increase in the number and size of institutional training grants to medical school pediatric departments and children's hospitals; and

`(2) an increase in the number of career development awards for pediatricians building careers in pediatric basic and clinical research.

`(c) AUTHORIZATION- For the purpose of carrying out this section, there are authorized to be appropriated such sums as may be necessary for each of the fiscal years 2000 through 2003.'.

Subtitle B--Other Programs

SEC. 111. CHILDHOOD IMMUNIZATIONS.

Section 317(j)(1) of the Public Health Service Act (42 U.S.C. 247b(j)(1)) is amended in the first sentence by striking `1998' and all that follows and inserting `1998 through 2003.'.

SEC. 112. SCREENINGS, REFERRALS, AND EDUCATION REGARDING LEAD POISONING.

Section 317A(l)(1) of the Public Health Service Act (42 U.S.C. 247b-1(l)(1)) is amended by striking `1994' and all that follows and inserting `1994 through 2003.'.

SEC. 113. PREVENTION AND CONTROL OF INJURIES; TRAUMATIC BRAIN INJURY.

Section 394A of the Public Health Service Act (42 U.S.C. 280b-3) is amended by striking `and' after `1994' and by inserting before the period the following: `, and such sums as may be necessary for each of the fiscal years 2000 through 2003.'.

TITLE II--CHILDREN'S HEALTH RESEARCH AND PREVENTION ACTIVITIES

Subtitle A--Early Detection, Diagnosis, and Treatment Regarding Hearing Loss in Infants

SEC. 201. SHORT TITLE.

This subtitle may be cited as the `Newborn and Infant Hearing Screening and Intervention Act of 1999'.

SEC. 202. EARLY DETECTION, DIAGNOSIS, AND INTERVENTIONS FOR NEWBORNS AND INFANTS WITH HEARING LOSS.

(a) DEFINITIONS- For the purposes of this subtitle only, the following terms in this section are defined as follows:

(1) HEARING SCREENING- Newborn and infant hearing screening consists of objective physiologic procedures to detect possible hearing loss and to identify newborns and infants who, after rescreening, require further audiologic and medical evaluations.

(2) AUDIOLOGIC EVALUATION- Audiologic evaluation consists of procedures to assess the status of the auditory system; to establish the site of the auditory disorder; the type and degree of hearing

loss, and the potential effects of hearing loss on communication; and to identify appropriate treatment and referral options. Referral options should include linkage to state IDEA Part C coordinating agencies or other appropriate agencies, medical evaluation, hearing aid/sensory aid assessment, audiologic rehabilitation treatment, national and local consumer, self-help, parent, and education organizations, and other family-centered services.

(3) MEDICAL EVALUATION- Medical evaluation by a physician consists of key components including history, examination, and medical decision making focused on symptomatic and related body systems for the purpose of diagnosing the etiology of hearing loss and related physical conditions, and for identifying appropriate treatment and referral options.

(4) MEDICAL INTERVENTION- Medical intervention is the process by which a physician provides medical diagnosis and direction for medical and/or surgical treatment options of hearing loss and/or related medical disorder associated with hearing loss.

(5) AUDIOLOGIC REHABILITATION- Audiologic rehabilitation (intervention) consists of procedures, techniques, and technologies to facilitate the receptive and expressive communication abilities of a child with hearing loss.

(6) EARLY INTERVENTION- Early intervention (e.g., nonmedical) means providing appropriate services for the child with hearing loss and ensuring that families of the child are provided comprehensive, consumer-oriented information about the full range of family support, training, information services, communication options and are given the opportunity to consider the full range of educational and program placements and options for their child.

(b) PURPOSES- The purposes of this subtitle are to clarify the authority within the Public Health Service Act to authorize statewide newborn and infant hearing screening, evaluation and intervention programs and systems, technical assistance, a national applied research program, and interagency and private sector collaboration for policy development, in order to assist the States in making progress toward the following goals:

(1) All babies born in hospitals in the United States and its territories should have a hearing screening before leaving the birthing facility. Babies born in other countries and residing in the United States via immigration or adoption should have a hearing screening as early as possible.

(2) All babies who are not born in hospitals in the United States and its territories should have a hearing screening within the first 3 months of life.

(3) Appropriate audiologic and medical evaluations should be conducted by 3 months for all newborns and infants suspected of having hearing loss to allow appropriate referral and provisions for audiologic rehabilitation, medical and early intervention before the age of 6 months.

(4) All newborn and infant hearing screening programs and systems should include a component for audiologic rehabilitation, medical and early intervention options that ensures linkage to any new and existing state-wide systems of intervention and rehabilitative services for newborns and infants with hearing loss.

(5) Public policy in regard to newborn and infant hearing screening and intervention should be based on applied research and the recognition that newborns, infants, toddlers, and children who are deaf or hard-of-hearing have unique language, learning, and communication needs, and should be the result of consultation with pertinent public and private sectors.

(c) STATEWIDE NEWBORN AND INFANT HEARING SCREENING, EVALUATION AND INTERVENTION PROGRAMS AND SYSTEMS- The Secretary of Health and Human Services (in this subtitle referred to as the `Secretary'), acting through the Administrator of the Health Resources and Services Administration, shall make awards of grants or cooperative agreements to develop statewide newborn and infant hearing screening, evaluation and intervention programs and systems for the following purposes:

(1) To develop and monitor the efficacy of state-wide newborn and infant hearing screening, evaluation and intervention programs and systems. Early intervention includes referral to schools and agencies, including community, consumer, and parent-based agencies and organizations and other programs mandated by Part C of the Individuals with Disabilities Education Act, which offer programs specifically designed to meet the unique language and communication needs of deaf and hard of hearing newborns, infants, toddlers, and children.

(2) To collect data on statewide newborn and infant hearing screening, evaluation and intervention programs and systems that can be used for applied research, program evaluation and policy development.

(d) TECHNICAL ASSISTANCE, DATA MANAGEMENT, AND APPLIED RESEARCH-

(1) CENTERS FOR DISEASE CONTROL AND PREVENTION- The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall make awards of grants or cooperative agreements to provide technical assistance to State agencies to complement an intramural program and to conduct applied research related to newborn and infant hearing screening, evaluation and intervention programs and systems. The program shall develop standardized procedures for data management and program effectiveness and costs, such as--

(A) to ensure quality monitoring of newborn and infant hearing loss screening, evaluation, and intervention programs and systems;

(B) to provide technical assistance on data collection and management;

(C) to study the costs and effectiveness of newborn and infant hearing screening, evaluation and intervention programs and systems conducted by State-based programs in order to

answer issues of importance to state and national policymakers;

(D) to identify the causes and risk factors for congenital hearing loss;

(E) to study the effectiveness of newborn and infant hearing screening, audiologic and medical evaluations and intervention programs and systems by assessing the health, intellectual and social developmental, cognitive, and language status of these children at school age; and

(F) to promote the sharing of data regarding early hearing loss with state-based birth defects and developmental disabilities monitoring programs for the purpose of identifying previously unknown causes of hearing loss.

(2) NATIONAL INSTITUTES OF HEALTH- The Director of the National Institutes of Health, acting through the Director of the National Institute on Deafness and Other Communication Disorders, shall for purposes of this section, continue a program of research and development on the efficacy of new screening techniques and technology, including clinical studies of screening methods, studies on efficacy of intervention, and related research.

(e) COORDINATION AND COLLABORATION-

(1) IN GENERAL- In carrying out programs under this section, the Administrator of the Health Resources and Services Administration, the Director of the Centers for Disease Control and Prevention, and the Director of the National Institutes of Health shall collaborate and consult with other Federal agencies; State and local agencies, including those responsible for early intervention services pursuant to Title XIX of the Social Security Act (Medicaid Early and Periodic Screening, Diagnosis and Treatment Program); Title XXI of the Social Security Act (State Children's Health Insurance Program); Title V of the Social Security Act (Maternal and Child Health Block Grant Program; and Part C of the Individuals with Disabilities Education Act); consumer groups of and that serve individuals who are deaf and hard-of-hearing and their families; appropriate national medical and other health and education specialty organizations; persons who are deaf and hard-of-hearing and their families; other qualified professional personnel who are proficient in deaf or hard-of-hearing children's language and who possess the specialized knowledge, skills, and attributes needed to serve deaf and hard-of-hearing newborns, infants, toddlers, children, and their families; third-party payers and managed care organizations; and related commercial industries.

(2) POLICY DEVELOPMENT- The Administrator of the Health Resources and Services Administration, the Director of the Centers for Disease Control and Prevention, and the Director of the National Institutes of Health shall coordinate and collaborate on recommendations for policy development at the Federal and state levels and with the private sector, including consumer, medical and other health and education professional-based organizations, with respect to newborn and infant hearing screening, evaluation and intervention programs and systems.

(3) STATE EARLY DETECTION, DIAGNOSIS, AND INTERVENTION PROGRAMS AND SYSTEMS; DATA COLLECTION- The Administrator of the Health Resources and Services Administration and the Director of the Centers for Disease Control and Prevention shall coordinate and collaborate in assisting States to establish newborn and infant hearing screening, evaluation and intervention programs and systems under subsection (c) and to develop a data collection system under subsection (d).

(f) RULE OF CONSTRUCTION- Nothing in this subtitle shall be construed to preempt any State law.

(g) AUTHORIZATION OF APPROPRIATIONS-

(1) STATEWIDE NEWBORN AND INFANT HEARING SCREENING, EVALUATION AND INTERVENTION PROGRAMS AND SYSTEMS- For the purpose of carrying out subsection (c), there are authorized to be appropriated to the Health Resources and Services Administration such sums as may be necessary for each of the fiscal years 2000 through 2003.

(2) TECHNICAL ASSISTANCE, DATA MANAGEMENT, AND APPLIED RESEARCH; CENTERS FOR DISEASE CONTROL AND PREVENTION- For the purpose of carrying out subsection (d)(1), there are authorized to be appropriated to the Centers for Disease Control and Prevention such sums as may be necessary for each of the fiscal years 2000 through 2003.

(3) TECHNICAL ASSISTANCE, DATA MANAGEMENT, AND APPLIED RESEARCH; NATIONAL INSTITUTE ON DEAFNESS AND OTHER COMMUNICATION DISORDERS- For the purpose of carrying out subsection (d)(2), there are authorized to be appropriated to the National Institute on Deafness and Other Communication Disorders such sums as may be necessary for each of the fiscal years 2000 through 2003.

Subtitle B--Autism

CHAPTER 1--SURVEILLANCE AND RESEARCH REGARDING PREVALENCE AND PATTERN OF AUTISM

SEC. 211. SHORT TITLE.

This chapter may be cited as the `Autism Statistics, Surveillance, Research, and Epidemiology Act of 1999 (ASSURE)'.

SEC. 212. DEVELOPMENTAL DISABILITIES SURVEILLANCE AND RESEARCH PROGRAMS.

(a) NATIONAL AUTISM AND PERVASIVE DEVELOPMENTAL DISABILITIES SURVEILLANCE PROGRAM- The Secretary of Health and Human Services (in this chapter referred to as the `Secretary'), acting through the Director of the Centers for Disease Control and Prevention, may make awards of grants and cooperative agreements for the collection, analysis, and reporting of data on autism and pervasive developmental disabilities. An entity may receive such an award only if the entity is a public or nonprofit private entity (including health departments of States and political subdivisions of States, and including universities and other educational entities). In making

such awards, the Secretary may provide direct technical assistance in lieu of cash.

(b) CENTERS OF EXCELLENCE IN AUTISM AND PERVASIVE DEVELOPMENTAL DISABILITIES EPIDEMIOLOGY-

(1) IN GENERAL- The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall (subject to the extent of amounts made available in appropriations Acts) establish not less than three, and not more than five, regional centers of excellence in autism and pervasive developmental disabilities epidemiology for the purpose of collecting and analyzing information on the number, incidence, correlates, and causes of autism and related developmental disabilities.

(2) RECIPIENTS OF AWARDS FOR ESTABLISHMENT OF CENTERS- Centers under paragraph (1) shall be established and operated through the award of grants or cooperative agreements to public or nonprofit private entities that conduct research, including health departments of States and political subdivisions of States, and including universities and other educational entities.

(3) CERTAIN REQUIREMENTS- An award for a center under paragraph (1) may be made only if the entity involved submits to the Secretary an application containing such agreements and information as the Secretary may require, including an agreement that the center involved will operate in accordance with the following:

(A) The center will collect, analyze, and report autism and pervasive developmental disabilities data according to guidelines prescribed by the Director, after consultation with relevant State and local public health officials, private sector developmental disability researchers, and advocates for those with developmental disabilities;

(B) The center will assist with the development and coordination of State autism and pervasive developmental disabilities surveillance efforts within a region;

(C) The center will provide education, training, and clinical skills improvement for health professionals aimed at better understanding and treatment of autism and related developmental disabilities; and

(D) The center will identify eligible cases and controls through its surveillance systems and conduct research into factors which may cause autism and related developmental disabilities; each program will develop or extend an area of special research expertise (including, but not limited to, genetics, environmental exposure to contaminants, immunology, and other relevant research specialty areas).

SEC. 213. CLEARINGHOUSE.

The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall carry out the following:

(1) The Centers for Disease Control and Prevention shall serve as the coordinating agency for autism and pervasive developmental disabilities surveillance activities through the establishment of a clearinghouse for the collection and storage of data generated from the monitoring programs created by this chapter. The functions of such a clearinghouse shall include facilitating the coordination of research and policy development relating to the epidemiology of autism and other pervasive developmental disabilities.

(2) The Secretary, acting through the Centers for Disease Control and Prevention, shall coordinate the Federal response to requests for assistance from State health department officials regarding potential or alleged autism or developmental disability clusters.

SEC. 214. ADVISORY COMMITTEE.

(a) IN GENERAL- The Secretary shall establish an Advisory Committee for Autism and Pervasive Developmental Disabilities Epidemiology Research (in this section referred to as the `Committee'). The Committee shall provide advice and recommendations to the Director of the Centers for Disease Control and Prevention on--

(1) the establishment of a national autism and pervasive developmental disabilities surveillance program;

(2) the establishment of centers of excellence in autism and pervasive developmental disabilities epidemiology;

(3) methods and procedures to more effectively coordinate government and non-government programs and research on autism and pervasive developmental disabilities epidemiology; and

(4) the effective operation of autism and pervasive developmental disabilities epidemiology research activities.

(b) COMPOSITION-

(1) IN GENERAL- The Committee shall be composed of ex officio members in accordance with paragraph (2) and 11 appointed members in accordance with paragraph (3).

(2) EX OFFICIO MEMBERS- The following officials shall serve as ex officio members of the Committee:

(A) The Director of the National Center for Environmental Health.

(B) The Assistant Administrator of the Agency for Toxic Substances and Disease Registry.

(C) The Director of the National Institute of Child Health and Human Development.

(D) The Director of the National Institute of Neurological Disorders and Stroke.

(3) APPOINTED MEMBERS- Appointments to the Committee shall be made in accordance with the following:

(A) Two members shall be research scientists with demonstrated achievements in research related to autism and related developmental disabilities. The scientists shall be appointed by the Secretary in consultation with the National Academy of Sciences.

(B) Five members shall be representatives of the five national organizations whose primary

emphasis is on research into autism and other pervasive developmental disabilities. One representative from each of such organizations shall be appointed by the Secretary in consultation with the National Academy of Sciences.

(C) Two members shall be clinicians whose practice is primarily devoted to the treatment of individuals with autism and other pervasive developmental disabilities. The clinicians shall be appointed by the Secretary in consultation with the Institute of Medicine and the National Academy of Sciences.

(D) Two members shall be individuals who are the parents or legal guardians of a person or persons with autism or other pervasive developmental disabilities. The individuals shall be appointed by the Secretary in consultation with the ex officio members under paragraph (1) and the five national organizations referred to in subparagraph (B).

(c) ADMINISTRATIVE SUPPORT; TERMS OF SERVICE; OTHER PROVISIONS- The following apply with respect to the Committee:

(1) The Committee shall receive necessary and appropriate administrative support from the Department of Health and Human Services.

(2) Members of the Committee shall be appointed for a term of three years, and may serve for an unlimited number of terms if reappointed.

(3) The Committee shall meet no less than two times per year.

(4) Members of the Committee shall not receive additional compensation for their service. Such members may receive reimbursement for appropriate and additional expenses that are incurred through service on the Committee which would not have incurred had they not been a member of the Committee.

SEC. 215. REPORT TO CONGRESS.

The Secretary shall prepare and submit to the Congress, after consultation and comment by the Advisory Committee, an annual report regarding the prevalence and incidence of autism and other pervasive developmental disorders, the results of research into the etiology of autism and other pervasive developmental disorders, public health responses to known or preventable causes of autism and other pervasive developmental disorders, and the need for additional research into promising lines of scientific inquiry.

SEC. 216. DEFINITION.

For purposes of this chapter, the term `State' means each of the several States, the District of Columbia, the Commonwealth of Puerto Rico, American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, the Virgin Islands, and the Trust Territory of the Pacific Islands.

SEC. 217. AUTHORIZATION OF APPROPRIATIONS.

For the purpose of carrying out this chapter, there are authorized to be appropriated such sums as may be necessary for each of the fiscal years 2000 through 2003.

CHAPTER 2--EXPANSION, INTENSIFICATION, AND COORDINATION OF ACTIVITIES OF DEPARTMENT OF HEALTH AND HUMAN SERVICES WITH RESPECT TO AUTISM

SEC. 218. SHORT TITLE.

This Act may be cited as the `Advancement in Pediatric Autism Research Act of 1999'.

SEC. 218A. EXPANSION, INTENSIFICATION, AND COORDINATION OF ACTIVITIES OF NATIONAL INSTITUTES OF HEALTH.

Part B of title IV of the Public Health Service Act (42 U.S.C. 284 et seq.) is amended by adding at the end the following section:

`AUTISM

`SEC. 409C. (a) IN GENERAL-

`(1) EXPANSION OF ACTIVITIES- The Director of NIH (in this section referred to as the `Director') shall expand, intensify, and coordinate the activities of the National Institutes of Health with respect to research on autism.

`(2) ADMINISTRATION OF PROGRAM; COLLABORATION AMONG AGENCIES- The Director shall carry out this section acting through the Director of the National Institute of Mental Health and in collaboration with any other agencies that the Director determines appropriate.

`(b) CENTERS OF EXCELLENCE-

`(1) IN GENERAL- The Director shall under subsection (a)(1) make awards of grants and contracts to public or nonprofit private entities to pay all or part of the cost of planning, establishing, improving, and providing basic operating support for centers of excellence regarding research on autism.

`(2) RESEARCH- Each center under paragraph (1) shall conduct basic and clinical research into autism. Such research should include investigations into the cause, diagnosis, early detection, prevention, control, and treatment of autism. These centers, as a group, shall conduct research including but not limited to the fields of developmental neurobiology, genetics, and psychopharmacology.

`(3) SERVICES FOR PATIENTS- A center under paragraph (1) may expend amounts provided under such paragraph to carry out a program to make individuals aware of opportunities to participate as subjects in research conducted by the centers. The program may, in accordance with such criteria as the Director may establish, provide to such subjects referrals for health and other services, and such patient care costs as are required for research. The extent to which the center can demonstrate availability and access to clinical services shall be considered by the Director in decisions about awarding the grants to applicants which meet the scientific criteria for funding.

`(4) COORDINATION OF CENTERS; REPORTS- The Director shall, as appropriate, provide for the coordination of information among centers under

paragraph (1) and ensure regular communication between such centers, and may require the periodic preparation of reports on the activities of the centers and the submission of the reports to the Director.

`(5) ORGANIZATION OF CENTERS- Each center under paragraph (1) shall use the facilities of a single institution, or be formed from a consortium of cooperating institutions, meeting such requirements as may be prescribed by the Director.

`(6) NUMBER OF CENTERS; DURATION OF SUPPORT- The Director shall provide for the establishment of not less than five centers under paragraph (1). Support of such a center may be for a period not exceeding 5 years. Such period may be extended for one or more additional periods not exceeding 5 years if the operations of such center have been reviewed by an appropriate technical and scientific peer review group established by the Director and if such group has recommended to the Director that such period should be extended.

`(c) FACILITATION OF RESEARCH- The Director shall under subsection (a)(1) provide for a program under which samples of tissues and genetic materials that are of use in research on autism are donated, collected, preserved, and made available for such research. The program shall be carried out in accordance with accepted scientific and medical standards for the donation, collection, and preservation of such samples.

`(d) PUBLIC INPUT- The Director shall under subsection (a)(1) provide for means through which the public can obtain information on the existing and planned programs and activities of the National Institutes of Health with respect to autism and through which the Director can receive comments from the public regarding such programs and activities.

`(e) FUNDING- For the purpose of carrying out this section, there are authorized to be appropriated such sums as may be necessary for each of the fiscal years 2000 through 2003. Such authorizations of appropriations are in addition to any other authorization of appropriations that is available for such purpose.'.

SEC. 219. DEVELOPMENTAL DISABILITIES SURVEILLANCE AND RESEARCH PROGRAMS.

(a) NATIONAL AUTISM AND PERVASIVE DEVELOPMENTAL DISABILITIES SURVEILLANCE PROGRAM- The Secretary of Health and Human Services (in this chapter referred to as the `Secretary'), acting through the Director of the Centers for Disease Control and Prevention, may make awards of grants and cooperative agreements for the collection, analysis, and reporting of data on autism and pervasive developmental disabilities. An entity may receive such an award only if the entity is a public or nonprofit private entity (including health departments of States and political subdivisions of States, and including universities and other educational entities). In making such awards, the Secretary may provide direct technical assistance in lieu of cash.

(b) CENTERS OF EXCELLENCE IN AUTISM AND PERVASIVE DEVELOPMENTAL DISABILITIES EPIDEMIOLOGY-

(1) IN GENERAL- The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall establish not less than 3, regional centers of excellence in autism and pervasive developmental disabilities epidemiology for the purpose of collecting and analyzing information on the number, incidence, correlates, and causes of autism and related developmental disabilities.

(2) RECIPIENTS OF AWARDS FOR ESTABLISHMENT OF CENTERS- Centers under paragraph (1) shall be established and operated through the awarding of grants or cooperative agreements to public or nonprofit private entities that conduct research, including health departments of States and political subdivisions of States, and including universities and other educational entities.

(3) CERTAIN REQUIREMENTS- An award for a center under paragraph (1) may be made only if the entity involved submits to the Secretary an application containing such agreements and information as the Secretary may require, including an agreement that the center involved will operate in accordance with the following:

(A) The center will collect, analyze, and report autism and pervasive developmental disabilities data according to guidelines prescribed by the Director, after consultation with relevant State and local public health officials, private sector developmental disability researchers, and advocates for those with developmental disabilities.

(B) The center will assist with the development and coordination of State autism and pervasive developmental disabilities surveillance efforts within a region.

(C) The center will identify eligible cases and controls through its surveillance systems and conduct research into factors which may cause autism and related developmental disabilities. Each program will develop or extend an area of special research expertise (including genetics, environmental exposure to contaminants, immunology, and other relevant research specialty areas).

(c) CLEARINGHOUSE- The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall carry out the following:

(1) The Secretary shall establish a clearinghouse within the Centers for Disease Control and Prevention for the collection and storage of data generated from the monitoring programs created by this chapter. Through the clearinghouse, such Centers shall serve as the coordinating agency for autism and pervasive developmental disabilities surveillance activities. The functions of such a clearinghouse shall include facilitating the coordination of research and policy development relating to the epidemiology of autism and other pervasive developmental disabilities.

(2) The Secretary, acting through the Centers for Disease Control and Prevention, shall coordinate the Federal response to requests for assistance from State health department officials regarding potential

or alleged autism or developmental disability clusters.

(d) DEFINITION- In this chapter, the term `State' means each of the several States, the District of Columbia, the Commonwealth of Puerto Rico, American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, the Virgin Islands, and the Trust Territory of the Pacific Islands.

(e) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out this section, there are authorized to be appropriated such sums as may be necessary for each of the fiscal years 2000 through 2003.

SEC. 220. INFORMATION AND EDUCATION.

(a) IN GENERAL- The Secretary shall establish and implement a program to provide information and education on autism to health professionals and the general public, including information and education on advances in the diagnosis and treatment of autism and training and continuing education through programs for scientists, physicians, and other health professionals who provide care for patients with autism.

(b) STIPENDS- The Secretary may use amounts made available under this section to provide stipends for health professionals who are enrolled in training programs under this section.

(c) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out this section, there are authorized to be appropriated such sums as may be necessary for each of the fiscal years 2000 through 2003.

SEC. 220A. INTERAGENCY AUTISM COORDINATING COMMITTEE.

(a) ESTABLISHMENT- The Secretary shall establish a committee to be known as the `Autism Coordinating Committee' (in this section referred to as the `Committee') to coordinate all efforts within the Department of Health and Human Services concerning autism, including activities carried out through the National Institutes of Health and the Centers for Disease Control and Prevention under this chapter (and the amendment made by this chapter).

(b) MEMBERSHIP-

(1) IN GENERAL- The Committee shall be composed of the Directors of such national research institutes, of the Centers for Disease Control and Prevention, and of such other agencies and such other officials as the Secretary determines appropriate.

(2) ADDITIONAL MEMBERS- If determined appropriate by the Secretary, the Secretary may appoint to the Committee--

(A) parents or legal guardians of individuals with autism or other pervasive developmental disorders; and

(B) representatives of other governmental agencies that serve children with autism such as the Department of Education.

(c) ADMINISTRATIVE SUPPORT; TERMS OF SERVICE; OTHER PROVISIONS- The following shall apply with respect to the Committee:

(1) The Committee shall receive necessary and appropriate administrative support from the Department of Health and Human Services.

(2) Members of the Committee appointed under subsection (b)(2)(A) shall serve for a term of 3 years, and may serve for an unlimited number of terms if reappointed.

(3) The Committee shall meet not less than 2 times per year.

SEC. 220B. REPORT TO CONGRESS.

Not later than January 1, 2000, and each January 1 thereafter, the Secretary shall prepare and submit to the appropriate committees of Congress, a report concerning the implementation of this chapter and the amendments made by this chapter.

Subtitle C--Poison Control Center Enhancement and Awareness

SEC. 221. SHORT TITLE.

This subtitle may be cited as the `Poison Control Center Enhancement and Awareness Act'.

SEC. 222. DEFINITION.

For purposes of this subtitle, the term `Secretary' means the Secretary of Health and Human Services.

SEC. 223. ESTABLISHMENT OF A NATIONAL TOLL-FREE NUMBER.

(a) IN GENERAL- The Secretary shall provide coordination and assistance to regional poison control centers for the establishment of a nationwide toll-free phone number to be used to access such centers.

(b) RULE OF CONSTRUCTION- Nothing in this section shall be construed as prohibiting the establishment or continued operation of any privately funded nationwide toll-free phone number used to provide advice and other assistance for poisonings or accidental exposures.

(c) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out this section, there are authorized to be appropriated such sums as may be necessary for each of the fiscal years 2000 through 2003. Funds appropriated under this subsection shall not be used to fund any toll-free phone number described in subsection (b).

SEC. 224. ESTABLISHMENT OF NATIONWIDE MEDIA CAMPAIGN.

(a) IN GENERAL- The Secretary shall establish a national media campaign to educate the public and health care providers about poison prevention and the availability of poison control resources in local communities and to conduct advertising campaigns concerning the nationwide toll-free number established under section 223.

(b) CONTRACT WITH ENTITY- The Secretary may carry out subsection (a) by entering into contracts with 1 or more nationally recognized media firms for the development and distribution of monthly television, radio, and newspaper public service announcements.

(c) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out this section, there are authorized to be appropriated such sums as may be necessary for each of the fiscal years 2000 through 2003.

SEC. 225. ESTABLISHMENT OF A GRANT PROGRAM.

(a) REGIONAL POISON CONTROL CENTERS- The Secretary shall award grants to certified regional poison control centers for the purposes of achieving the financial stability of such centers, and for preventing and providing treatment recommendations for poisonings.

(b) OTHER IMPROVEMENTS- The Secretary shall also use amounts received under this section to--

(1) develop standard education programs;

(2) develop standard patient management protocols for commonly encountered toxic exposures;

(3) improve and expand the poison control data collection systems;

(4) improve national toxic exposure surveillance; and

(5) expand the physician/medical toxicologist supervision of poison control centers.

(c) CERTIFICATION- Except as provided in subsection (d), the Secretary may make a grant to a center under subsection (a) only if--

(1) the center has been certified by a professional organization in the field of poison control, and the Secretary has approved the organization as having in effect standards for certification that reasonably provide for the protection of the public health with respect to poisoning; or

(2) the center has been certified by a State government, and the Secretary has approved the State government as having in effect standards for certification that reasonably provide for the protection of the public health with respect to poisoning.

(d) WAIVER OF CERTIFICATION REQUIREMENTS-

(1) IN GENERAL- The Secretary may grant a waiver of the certification requirement of subsection (c) with respect to a noncertified poison control center or a newly established center that applies for a grant under this section if such center can reasonably demonstrate that the center will obtain such a certification within a reasonable period of time as determined appropriate by the Secretary.

(2) RENEWAL- The Secretary may only renew a waiver under paragraph (1) for a period of 3 years.

(e) SUPPLEMENT NOT SUPPLANT- Amounts made available to a poison control center under this section shall be used to supplement and not supplant other Federal, State, or local funds provided for such center.

(f) MAINTENANCE OF EFFORT- A poison control center, in utilizing the proceeds of a grant under this section, shall maintain the expenditures of the center for activities of the center at a level that is not less than the level of such expenditures maintained by the center for the fiscal year preceding the fiscal year for which the grant is received.

(g) MATCHING REQUIREMENT- The Secretary may impose a matching requirement with respect to amounts provided under a grant under this section if the Secretary determines appropriate.

(h) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out this section, there are authorized to be appropriated such sums as may be necessary for each of the fiscal years 2000 through 2003.

Subtitle D--Birth Defects Prevention Activities

CHAPTER 1--FOLIC ACID

SEC. 231. SHORT TITLE.

This chapter may be cited as the `Folic Acid Promotion and Birth Defects Prevention Act of 1999'.

SEC. 232. PROGRAM REGARDING EFFECTS OF FOLIC ACID IN PREVENTION OF BIRTH DEFECTS.

Part B of title III of the Public Health Service Act (42 U.S.C. 243 et seq.) is amended by inserting after section 317G the following section:

`EFFECTS OF FOLIC ACID IN PREVENTION OF BIRTH DEFECTS

`SEC. 317H. (a) IN GENERAL- The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall carry out a program (directly or through grants or contracts) for the following purposes:

`(1) To provide education and training for health professionals and the general public for purposes of explaining the effects of folic acid in preventing birth defects and for purposes of encouraging each woman of reproductive capacity (whether or not planning a pregnancy) to consume on a daily basis a dietary supplement that provides an appropriate level of folic acid.

`(2) To conduct research with respect to such education and training, including identifying effective strategies for increasing the rate of consumption of folic acid by women of reproductive capacity.

`(3) To conduct research to increase the understanding of the effects of folic acid in preventing birth defects, including understanding with respect to cleft lip, cleft palate, and heart defects.

`(4) To provide for appropriate epidemiological activities regarding folic acid and birth defects, including epidemiological activities regarding neural tube defects.

`(b) CONSULTATIONS WITH STATES AND PRIVATE ENTITIES- In carrying out subsection (a), the Secretary shall consult with the States and with other appropriate public or private entities, including national nonprofit private organizations, health professionals, and providers of health insurance and health plans.

`(c) TECHNICAL ASSISTANCE- The Secretary may (directly or through grants or contracts) provide technical assistance to public and nonprofit private entities in carrying out the activities described in subsection (a).

`(d) EVALUATIONS- The Secretary shall (directly or through grants or contracts) provide for the evaluation of activities under subsection (a) in order to determine the extent to which such activities have been effective in carrying out the purposes of the program under such subsection, including the effects on various demographic populations. Methods of evaluation under the preceding sentence may include surveys of knowledge and attitudes on the consumption of folic acid and on blood folate levels. Such methods may include complete and timely monitoring of infants who are born with neural tube defects.

`(e) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out this section, there are authorized to be appropriated such sums as may be necessary for each of the fiscal years 2000 through 2003.'.

CHAPTER 2--NATIONAL CENTER ON BIRTH DEFECTS AND DEVELOPMENTAL DISABILITIES

SEC. 236. NATIONAL CENTER ON BIRTH DEFECTS AND DEVELOPMENTAL DISABILITIES.

Title III of the Public Health Service Act (42 U.S.C. 241 et seq.) is amended--

(1) in part O--

(A) by redesignating sections 399G through 399J as sections 399M through 399P, respectively;

(B) in section 399O(b) (as so redesignated), by striking `section 399G(d)' and inserting `section 399M(d)'; and

(C) in section 399P (as so redesignated), by striking `section 399G(d)(1)' and inserting `section 399M(d)(1)'; and

(2) by adding at the end the following part:

`Part P--Pediatric Public Health Promotion

`SEC. 399Q. NATIONAL CENTER ON BIRTH DEFECTS AND DEVELOPMENTAL DISABILITIES.

`(a) ESTABLISHMENT- There is established within the Centers for Disease Control and Prevention a center to be known as the National Center on Birth Defects and Developmental Disabilities.

`(b) PURPOSE- The general purpose of the National Center established under subsection (a) shall be to--

`(1) collect, analyze, and make available data on birth defects, including data on the causes of such defects and on the incidence and prevalence of such defects;

`(2) conduct applied epidemiological research on the prevention of such defects; and

`(3) provide information and education to the public on the prevention of such defects.

`(c) DIRECTOR- The National Center established under subsection (a) shall be headed by a director to be appointed by the Secretary.

`(d) TRANSFERS- There shall be transferred to the National Center established under subsection (a) all activities, budgets and personnel of the National Center for Environmental Health that relate to birth defects, folic acid, cerebral palsy, mental retardation, child development, newborn screening, autism, fragile X syndrome, fetal alcohol syndrome, pediatric genetics, and disability prevention.

`(e) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out this section, there are authorized to be appropriated such sums as may be necessary for each of the fiscal years 2000 through 2003.'.

Subtitle E--Safe Motherhood Monitoring and Prevention Research

SEC. 241. SHORT TITLE.

This subtitle may be cited as the `Safe Motherhood Monitoring and Prevention Research Act'.

SEC. 242. AMENDMENT TO PUBLIC HEALTH SERVICE ACT.

Title III of the Public Health Service Act, as amended by section 236 of this Act, is amended by adding at the end the following part:

`Part Q--Safe Motherhood

`SEC. 399R. SAFE MOTHERHOOD MONITORING.

`(a) PURPOSE- It is the purpose of this section to develop monitoring systems at the local, State, and national level to better understand the burden of maternal complications and mortality and to decrease the disparities among population at risk of death and complications from pregnancy.

`(b) ACTIVITIES- For the purpose described in subsection (a), the Secretary may carry out the following activities:

`(1) The Secretary may establish and implement a national monitoring and surveillance program to identify and promote the investigation of deaths and severe complications that occur during pregnancy.

`(2) The Secretary may expand the Pregnancy Risk Assessment Monitoring System to provide surveillance and collect data in each of the 50 States.

`(3) The Secretary may expand the Maternal and Child Health Epidemiology Program to provide technical support, financial assistance, or the time-limited assignment of senior epidemiologists to maternal and child health programs in each of the 50 States.

`(c) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out this section, there are authorized to be appropriated such sums as may be necessary for each of the fiscal years 2000 through 2003.'.

`SEC. 399S. PREVENTION RESEARCH TO ENSURE SAFE MOTHERHOOD.

`(a) PURPOSE- It is the purpose of this section to provide the Secretary with the authority to further expand research concerning risk factors, prevention strategies, and the roles of the family, health care providers and the community in safe motherhood.

`(b) RESEARCH- The Secretary may carry out activities to expand research relating to--

`(1) encouraging preconception counseling, especially for at risk populations such as diabetics;

`(2) the identification of critical components of prenatal delivery and postpartum care;

`(3) the identification of outreach and support services, such as folic acid education, that are available for pregnant women;

`(4) the identification of women who are at high risk for complications;

`(5) preventing preterm delivery;

`(6) preventing urinary tract infections;

`(7) preventing unnecessary caesarean sections;

`(8) an examination of the higher rates of maternal mortality among African American women;

`(9) an examination of the relationship between domestic violence and maternal complications and mortality;

`(10) preventing smoking, alcohol and illegal drug usage before, during and after pregnancy;

`(11) preventing infections that cause maternal and infant complications; and

`(12) other areas determined appropriate by the Secretary.

`(c) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out this section, there are authorized to be appropriated such sums as may be necessary for each of the fiscal years 2000 through 2003.

`SEC. 399T. PREVENTION PROGRAMS TO ENSURE SAFE MOTHERHOOD.

`(a) IN GENERAL- The Secretary may carry out activities to promote safe motherhood, including--

`(1) public education campaigns on healthy pregnancies and the building of partnerships with outside organizations concerned about safe motherhood;

`(2) education programs for physicians, nurses and other health care providers; and

`(3) activities to promote community support services for pregnant women.

`(b) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out this section, there are authorized to be appropriated such sums as may be necessary for each of the fiscal years 2000 through 2003.'.

Subtitle F--Pregnant Mothers and Infants Health Promotion

SEC. 251. SHORT TITLE.

This subtitle may be cited as the `Pregnant Mothers and Infants Health Protection Act'.

SEC. 252. ESTABLISHMENT.

Title III of the Public Health Service Act, as amended by section 242 of this Act, is amended by adding at the end the following part:

`Part R--Additional Programs

`SEC. 399U. PROGRAMS REGARDING PRENATAL AND POSTNATAL HEALTH.

`(a) IN GENERAL- The Secretary shall carry out programs--

`(1) to collect, analyze, and make available data on prenatal smoking, alcohol and illegal drug usage, including data on the implications of such activities and on the incidence and prevalence of such activities and their implications;

`(2) to conduct applied epidemiological research on the prevention of prenatal and postnatal smoking, alcohol and illegal drug usage;

`(3) to support, conduct, and evaluate the effectiveness of educational and cessation programs; and

`(4) to provide information and education to the public on the prevention and implications of prenatal and postnatal smoking, alcohol and illegal drug usage.

`(b) GRANTS- In carrying out subsection (a), the Secretary may award grants to and enter into contracts with States, local governments, scientific and academic institutions, Federally qualified health centers, and other public and nonprofit entities, and may provide technical and consultative assistance to such entities.

`(c) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out this section, there are authorized to be appropriated such sums as may be necessary for each of the fiscal years 2000 through 2003.'.

Subtitle G--Utilization of Preventive Health Services

SEC. 261. GRANTS REGARDING UTILIZATION OF PREVENTIVE HEALTH SERVICES.

Part D of title III of the Public Health Service Act (42 U.S.C. 254b et seq.) is amended by adding at the end the following section:

`SEC. 330D. CENTERS FOR STRATEGIES ON FACILITATING UTILIZATION OF PREVENTIVE HEALTH SERVICES AMONG VARIOUS POPULATIONS.

`(a) IN GENERAL- The Secretary, acting through the appropriate agencies of the Public Health Service, shall make grants to public or nonprofit private entities for the establishment and operation of regional centers whose purpose is to identify particular populations of patients and facilitate the appropriate utilization of preventive health services by patients in the populations through developing and disseminating strategies to improve the methods used by public and private health care programs and providers in interacting with such patients.

`(b) RESEARCH AND TRAINING- The activities carried out by a center under subsection (a) may include establishing programs of research and training with respect to the purpose described in such subsection, including the development of curricula for training individuals in implementing the strategies developed under such subsection.

`(c) QUALITY MANAGEMENT- A condition for the receipt of a grant under subsection (a) is that the applicant involved agree that, in order to ensure that the strategies developed under such subsection take into account principles of quality management with respect to consumer satisfaction, the applicant will make arrangements with one or more private entities that have experience in applying such principles.

`(d) PRIORITY REGARDING INFANTS AND CHILDREN- In carrying out the purpose described in subsection (a), the Secretary shall give priority to various populations of infants, young children, and their mothers.

`(e) EVALUATIONS- The Secretary, acting through the appropriate agencies of the Public Health Service, shall (directly or through grants or contracts) provide for the evaluation of strategies under subsection (a) in order to determine the extent to which the strategies have been effective in facilitating the appropriate utilization of preventive health services in the populations with respect to which the strategies were developed.

`(f) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out this section, there are authorized to be appropriated such sums as may be necessary for each of the fiscal years 2000 through 2003.'.

Subtitle H--Research and Development Regarding Fragile X

SEC. 266. SHORT TITLE.

This subtitle may be cited as the `Fragile X Research Breakthrough Act of 1999'.

SEC. 267. NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT; RESEARCH ON FRAGILE X.

Subpart 7 of part C of title IV of the Public Health Service Act, as amended by section 103 of this Act, is amended by adding at the end the following section:

`FRAGILE X

`SEC. 452F. (a) EXPANSION AND COORDINATION OF RESEARCH ACTIVITIES- The Director of the Institute, after consultation with the advisory council for the Institute, shall expand, intensify, and coordinate the activities of the Institute with respect to research on the disease known as fragile X.

`(b) RESEARCH CENTERS-

`(1) IN GENERAL- The Director of the Institute, after consultation with the advisory council for the Institute, shall make grants to, or enter into contracts with, public or nonprofit private entities

for the development and operation of centers to conduct research for the purposes of improving the diagnosis and treatment of, and finding the cure for, fragile X.

`(2) NUMBER OF CENTERS- In carrying out paragraph (1), the Director of the Institute shall, to the extent that amounts are appropriated, provide for the establishment of at least three fragile X research centers.

`(3) ACTIVITIES-

`(A) IN GENERAL- Each center assisted under paragraph (1) shall, with respect to fragile X--

`(i) conduct basic and clinical research, which may include clinical trials of--

`(I) new or improved diagnostic methods; and

`(II) drugs or other treatment approaches; and

`(ii) conduct research to find a cure.

`(B) FEES- A center may use funds provided under paragraph (1) to provide fees to individuals serving as subjects in clinical trials conducted under subparagraph (A).

`(4) COORDINATION AMONG CENTERS- The Director of the Institute shall, as appropriate, provide for the coordination of the activities of the centers assisted under this section, including providing for the exchange of information among the centers.

`(5) CERTAIN ADMINISTRATIVE REQUIREMENTS- Each center assisted under paragraph (1) shall use the facilities of a single institution, or be formed from a consortium of cooperating institutions, meeting such requirements as may be prescribed by the Director of the Institute.

`(6) DURATION OF SUPPORT- Support may be provided to a center under paragraph (1) for a period not exceeding 5 years. Such period may be extended for one or more additional periods, each of which may not exceed 5 years, if the operations of such center have been reviewed by an appropriate technical and scientific peer review group established by the Director and if such group has recommended to the Director that such period be extended.

`(7) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out this subsection, there are authorized to be appropriated such sums as may be necessary for each of the fiscal years 2000 through 2003.'.

SEC. 268. NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT; LOAN REPAYMENT PROGRAM REGARDING RESEARCH ON FRAGILE X.

Part G of title IV of the Public Health Service Act (42 U.S.C. 288 et seq.) is amended by inserting after section 487E the following section:

`LOAN REPAYMENT PROGRAM REGARDING RESEARCH ON FRAGILE X

`SEC. 487F. (a) IN GENERAL- The Secretary, in consultation with the Director of the National Institute of Child Health and Human Development, shall establish a program under which the Federal Government enters into contracts with qualified health professionals (including graduate students) who agree to conduct research regarding fragile X in consideration of the Federal Government's agreement to repay, for each year of such service, not more than $35,000 of the principal and interest of the educational loans owed by such health professionals.

`(b) APPLICABILITY OF CERTAIN PROVISIONS- With respect to the National Health Service Corps Loan Repayment Program established in subpart III of part D of title III, the provisions of such subpart (including section 338B(g)(3)) shall, except as inconsistent with subsection (a) of this section, apply to the program established in such subsection in the same manner and to the same extent as such provisions apply to the National Health Service Corps Loan Repayment Program established in such subpart.

`(c) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out this section, there are authorized to be appropriated such sums as may be necessary for each of the fiscal years 2000 through 2003.'.

Subtitle I--Children and Epilepsy

SEC. 271. PROGRAMS OF THE CENTERS FOR DISEASE CONTROL AND PREVENTION; NATIONAL PUBLIC HEALTH CAMPAIGN ON EPILEPSY.

(a) IN GENERAL- The Secretary of Health and Human Services (in this subtitle referred to as the `Secretary'), acting through the Director of the Centers for Disease Control and Prevention, shall develop and implement public health surveillance, education, research, and intervention strategies to improve the lives of persons with epilepsy, with a particular emphasis on children. Such projects may be carried out by the Secretary directly and through awards of grants or contracts to public or nonprofit private entities. The Secretary may directly or through such awards provide technical assistance with respect to the planning, development, and operation of such projects.

(b) CERTAIN ACTIVITIES- Activities under subsection (a) shall include--

(1) expanding current surveillance activities through existing monitoring systems and improving registries that maintain data on individuals with epilepsy, including children;

(2) enhancing research activities on the management and control of epilepsy;

(3) implementing public and professional information and education programs regarding epilepsy, including initiatives which promote effective management and control of the disease through children's programs which are targeted to parents, schools, daycare providers, patients;

(4) undertaking educational efforts with the media, providers of health care, schools and others regarding stigmas and secondary disabilities related to epilepsy and seizures, and also its affects on youth;

(5) utilizing and expanding partnerships with organizations with experience addressing the health and related needs of people with disabilities; and

(6) other activities the Secretary deems appropriate.

(c) COORDINATION OF ACTIVITIES- The Secretary shall ensure that activities under this section are coordinated as appropriate with other agencies of the Public Health Service that carry out activities regarding epilepsy and seizure.

(d) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out this section, there are authorized to be appropriated such sums as may be necessary for each of the fiscal years 2000 through 2003.

SEC. 272. PROGRAMS OF HEALTH RESOURCES AND SERVICES ADMINISTRATION; STATE AND LOCAL GRANTS FOR SEIZURE DISORDER DEMONSTRATION PROJECTS IN MEDICALLY UNDERSERVED AREAS.

(a) IN GENERAL- The Secretary, acting through the Administrator of the Health Resources and Services Administration, may make grants to States and local governments for the purpose of carrying out demonstration projects to improve access to health and other services regarding seizures to encourage early detection and treatment in children and others residing in medically underserved areas.

(b) APPLICATION FOR GRANT- The Secretary may make a grant under subsection (a) only if the application for the grant is submitted to the Secretary and the application is in such form, is made in such matter, and contains such agreements, assurances, and information as the Secretary determines to be necessary to carry out this section.

(c) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out this section, there are authorized to be appropriated such sums as may be necessary for each of the fiscal years 2000 through 2003.

SEC. 273. DEFINITIONS.

For purposes of this subtitle:

(1) The term `epilepsy' refers to a chronic and serious neurological condition which produces excessive electrical discharges in the brain causing recurring seizures affecting all life activities. The Secretary may revise the definition of such term as the Secretary.

(2) The term `medically underserved' has the meaning applicable under section 799B(6) of the Public Health Service Act.

Subtitle J--Asthma Treatment Services for Children

SEC. 276. SHORT TITLE.

This subtitle may be cited as the `Children's Asthma Relief Act of 1999'.

SEC. 277. CHILDREN'S ASTHMA RELIEF.

Title III of the Public Health Service Act, as amended by section 252 of this Act, is amended by adding at the end the following:

`Part S--Children's Asthma Relief

`SEC. 399V. ASTHMA TREATMENT GRANTS PROGRAM.

`(a) PURPOSES- The purposes of this section are as follows:

`(1) To provide access to quality medical care for children who live in areas that have a high prevalence of asthma and who lack access to medical care.

`(2) To provide on-site education to parents, children, health care providers, and medical teams to recognize the signs and symptoms of asthma, and to train them in the use of medications to prevent and treat asthma.

`(3) To decrease preventable trips to the emergency room by making medication available to individuals who have not previously had access to treatment or education in the prevention of asthma.

`(4) To provide other services, such as smoking cessation programs, home modification, and other direct and support services that ameliorate conditions that exacerbate or induce asthma.

`(b) AUTHORITY TO MAKE GRANTS-

`(1) IN GENERAL- In addition to any other payments made under this Act or title V of the Social Security Act, the Secretary shall award grants to eligible entities to carry out the purposes of this section, including grants that are designed to develop and expand projects to--

`(A) provide comprehensive asthma services to children, including access to care and treatment for asthma in a community-based setting;

`(B) fully equip mobile health care clinics that provide preventive asthma care including diagnosis, physical examinations, pharmacological therapy, skin testing, peak flow meter testing, and other asthma-related health care services;

`(C) conduct study validated asthma management education programs for patients with asthma and their families, including patient education regarding asthma management, family education on asthma management, and the distribution of materials, including displays and videos, to reinforce concepts presented by medical teams; and

`(D) identify eligible children for the medicaid program under title XIX of the Social Security Act, the State Children's Health Insurance Program under title XXI of such Act, or other children's health programs.

`(2) AWARD OF GRANTS-

`(A) APPLICATION-

`(i) IN GENERAL- An eligible entity shall submit an application to the Secretary for a grant under this section in such form and manner as the Secretary may require.

`(ii) REQUIRED INFORMATION- An application submitted under this subparagraph shall include a plan for the use of funds awarded under the grant and such other information as the Secretary may require.

`(B) REQUIREMENT- In awarding grants under this section, the Secretary shall give preference to eligible entities that demonstrate that the activities to be carried out under this section shall be in localities within areas of known high prevalence of childhood asthma or high asthma-related mortality (relative to the average asthma incidence rates and associated mortality rates in the United States). Acceptable data sets to demonstrate a high prevalence of childhood asthma or high asthma-related mortality may include data from Federal, State, or local vital statistics, claims data under title XIX or XXI of the Social Security Act, other public health statistics or surveys, or other data that the Secretary, in consultation with the Director of the Centers for Disease Control and Prevention, deems appropriate.

`(3) DEFINITION OF ELIGIBLE ENTITY- For purposes of this section, the term `eligible entity' means a State agency or other entity receiving funds under title V of the Social Security Act, a local community, a nonprofit children's hospital or foundation, or a nonprofit community-based organization.

`(c) COORDINATION WITH OTHER CHILDREN'S PROGRAMS- An eligible entity shall identify in the plan submitted as part of an application for a grant under this section how the entity will coordinate operations and activities under the grant with--

`(1) other programs operated in the State that serve children with asthma, including any such programs operated under titles V, XIX, or XXI of the Social Security Act; and

`(2) one or more of the following--

`(A) the child welfare and foster care and adoption assistance programs under parts B and E of title IV of such Act;

`(B) the head start program established under the Head Start Act (42 U.S.C. 9831 et seq.);

`(C) the program of assistance under the special supplemental nutrition program for women, infants and children (WIC) under section 17 of the Child Nutrition Act of 1966 (42 U.S.C. 1786);

`(D) local public and private elementary or secondary schools; or

`(E) public housing agencies, as defined in section 3 of the United States Housing Act of 1937 (42 U.S.C. 1437a).

`(d) EVALUATION- An eligible entity that receives a grant under this section shall submit to the Secretary an evaluation of the operations and activities carried out under the grant that includes--

`(1) a description of the health status outcomes of children assisted under the grant;

`(2) an assessment of the utilization of asthma-related health care services as a result of activities carried out under the grant;

`(3) the collection, analysis, and reporting of asthma data according to guidelines prescribed by the Director of the Centers for Disease Control and Prevention; and

`(4) such other information as the Secretary may require.

`(e) APPLICABILITY OF CERTAIN PROVISIONS- The following provisions of title V of the Social Security Act shall apply to a grant made under this section to the same extent and in the same manner as such provisions apply to allotments made under section 502(c) of such Act:

`(1) Section 504(b)(4) (relating to expenditures of funds as a condition of receipt of Federal funds).

`(2) Section 504(b)(6) (relating to prohibition on payments to excluded individuals and entities).

`(3) Section 506 (relating to reports and audits, but only to the extent determined by the Secretary to be appropriate for grants made under this section).

`(4) Section 508 (relating to nondiscrimination).

`(f) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out this section, there are authorized to be appropriated such sums as may be necessary for each of the fiscal years 2000 through 2003.'.

SEC. 278. INCORPORATION OF ASTHMA PREVENTION TREATMENT AND SERVICES INTO STATE CHILDREN'S HEALTH INSURANCE PROGRAMS.

(a) IN GENERAL- The Secretary of Health and Human Services (in this section referred to as the `Secretary') shall, in accordance with subsection (b), carry out a program to encourage States to implement plans to carry out activities to assist children with respect to asthma in accordance with guidelines of the National Asthma Education and Prevention Program (NAEPP) and the National Heart, Lung and Blood Institute.

(b) RELATION TO CHILDREN'S HEALTH INSURANCE PROGRAM-

(1) IN GENERAL- Subject to paragraph (2), if a State child health plan under title XXI of the Social Security Act (42 U.S.C. 1397aa et seq.) provides for activities described in subsection (a) to an extent satisfactory to the Secretary, the Secretary shall, with amounts appropriated under subsection

(c), make a grant to the State involved to assist the State in carrying out such activities.

(2) CRITERIA REGARDING ELIGIBILITY FOR GRANT; RULE OF CONSTRUCTION REGARDING AUTHORITY OF SECRETARY- The Secretary shall publish in the Federal Register criteria describing the circumstances in which the Secretary will consider a State plan to be satisfactory for purposes of paragraph (1), subject to the condition that this section may not be construed as modifying (or authorizing the Secretary to modify) any requirement or authority established in or under title XXI of the Social Security Act.

(3) REQUIREMENT OF MATCHING FUNDS-

(A) IN GENERAL- With respect to the costs of the activities to be carried out by a State pursuant to paragraph (1), the Secretary may make a grant under such paragraph only if the State agrees to make available (directly or through donations from public or private entities) non-Federal contributions toward such costs in an amount that is not less than 15 percent of the costs.

(B) DETERMINATION OF AMOUNT CONTRIBUTED- Non-Federal contributions required in subparagraph (A) may be in cash or in kind, fairly evaluated, including 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.

(4) TECHNICAL ASSISTANCE- With respect to State child health plans under title XXI of the Social Security Act (42 U.S.C. 1397aa et seq.), the Secretary, acting through the Director of the Centers for Disease Control and Prevention, in consultation with the heads of other Federal agencies involved in asthma treatment and prevention, shall make available to the States technical assistance in developing the provision of such plans that will provide for activities pursuant to paragraph (1).

(c) FUNDING- For the purpose of carrying out this section, there are authorized to be appropriated such sums as may be necessary for each of the fiscal years 2000 through 2003.

SEC. 279. PREVENTIVE HEALTH AND HEALTH SERVICES BLOCK GRANT; SYSTEMS FOR REDUCING ASTHMA AND ASTHMA-RELATED ILLNESSES THROUGH URBAN COCKROACH MANAGEMENT.

Section 1904(a)(1) of the Public Health Service Act (42 U.S.C. 300w-3(a)(1)) is amended--

(1) by redesignating subparagraphs (E) and (F) as subparagraphs (F) and (G), respectively;

(2) by adding a period at the end of subparagraph (G) (as so redesignated);

(3) by inserting after subparagraph (D), the following:

`(E) The establishment, operation, and coordination of effective and cost-efficient systems to reduce the prevalence of asthma and asthma-related illnesses among urban populations, especially children, by reducing the level of exposure to cockroach allergen through the use of integrated pest management, as applied to cockroaches. Amounts expended for such systems may include the costs of structural rehabilitation of housing, public schools, and other public facilities to reduce cockroach infestation, the costs of building maintenance, and the costs of programs to promote community participation in the carrying out at such sites of integrated pest management, as applied to cockroaches. For purposes of this subparagraph, the term `integrated pest management' means an approach to the management of pests in public facilities that combines biological, cultural, physical, and chemical tools in a way that minimizes economic, health, and environmental risks.';

(4) in subparagraph (F) (as so redesignated), by striking `subparagraphs (A) through (D)' and inserting `subparagraphs (A) through (E)'; and

(5) in subparagraph (G) (as so redesignated), by striking `subparagraphs (A) through (E)' and inserting `subparagraphs (A) through (F)'.

SEC. 279A. COORDINATION OF FEDERAL ACTIVITIES TO ADDRESS ASTHMA-RELATED HEALTH CARE NEEDS.

(a) IN GENERAL- The Director of the National Heart, Lung, and Blood Institute shall, through the National Asthma Education Prevention Program Coordinating Committee--

(1) identify all Federal programs that carry out asthma-related activities;

(2) develop, in consultation with appropriate Federal agencies and professional and voluntary health organizations, a Federal plan for responding to asthma; and

(3) not later than 12 months after the date of enactment of this Act, submit recommendations to Congress on ways to strengthen and improve the coordination of asthma-related activities of the Federal Government.

(b) REPRESENTATION OF THE DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT- A representative of the Department of Housing and Urban Development shall be included on the National Asthma Education Prevention Program Coordinating Committee for the purpose of performing the tasks described in subsection (a).

(c) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out this section, there are authorized to be appropriated such sums as may be necessary for each of the fiscal years 2000 through 2003.

SEC. 279B. COMPILATION OF DATA BY THE CENTERS FOR DISEASE CONTROL AND PREVENTION.

(a) IN GENERAL- The Director of the Centers for Disease Control and Prevention, in consultation with the National Asthma Education Prevention Program Coordinating Committee, shall--

(1) conduct local asthma surveillance activities to collect data on the prevalence and severity of

asthma and the quality of asthma management, including--

(A) telephone surveys to collect sample household data on the local burden of asthma; and

(B) health care facility specific surveillance to collect asthma data on the prevalence and severity of asthma, and on the quality of asthma care; and

(2) compile and annually publish data on--

(A) the prevalence of children suffering from asthma in each State; and

(B) the childhood mortality rate associated with asthma nationally and in each State.

(b) COLLABORATIVE EFFORTS- The activities described in subsection (a)(1) may be conducted in collaboration with eligible entities awarded a grant under section 399V of the Public Health Service Act (as added by section 277 of this Act).

Subtitle K--Juvenile Arthritis and Related Conditions

SEC. 281. RESEARCH ON JUVENILE ARTHRITIS AND RELATED CONDITIONS.

(a) ESTABLISHMENT- The Directors of the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the National Institute of Allergy and Infectious Diseases shall expand and intensify the programs of such Institutes with respect to research and related activities concerning juvenile arthritis and related conditions.

(b) COORDINATION- The Directors referred to in subsection (a) shall jointly coordinate the programs referred to in such subsection and consult with the Arthritis and Musculoskeletal Diseases Interagency Coordinating Committee.

(c) INFORMATION RESOURCE CENTER-

(1) IN GENERAL- In order to assist in carrying out the purpose described in subsection (a), the Director of the National Institutes of Health shall provide for the establishment of an information resource center on arthritis and related conditions, including juvenile arthritis, to facilitate and enhance knowledge and understanding on the part of patients, health professionals, and the public through the effective dissemination of information.

(2) ESTABLISHMENT THROUGH GRANT OR CONTRACT- For the purpose of carrying out paragraph (1), the Director of the National Institutes of Health shall enter into a grant, cooperative agreement, or contract with a national, nonprofit private entity involved in activities regarding the prevention and control of arthritis and related conditions through the National Arthritis Action Plan.

(c) PEDIATRIC RHEUMATOLOGY- The Secretary of Health and Human Services, acting through the Director of the National Institutes of Health and the Administrator of the Health Resources and Services Administration, shall develop a coordinated effort to ensure that a national infrastructure is in place to train and develop pediatric rheumatologists to address the health care services requirements of children with arthritis and related conditions.

(d) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out this section, there are authorized to be appropriated such sums as may be necessary for each of the fiscal years 2000 through 2003.

Subtitle L--Childhood Skeletal Malignancies

SEC. 286. PROGRAMS OF CENTERS FOR DISEASE CONTROL AND PREVENTION.

(a) IN GENERAL- The Secretary of Health and Human Services (in this section referred to as the `Secretary'), acting through the Director of the Centers for Disease Control and Prevention, shall study environmental and other risk factors for childhood skeletal cancers, and carry out projects to improve outcomes among children with childhood skeletal cancers and resultant secondary conditions, including limb loss. Such projects shall be carried out by the Secretary directly and through awards of grants or contracts to public or nonprofit entities.

(b) CERTAIN ACTIVITIES- Activities under subsection (a) include--

(1) the expansion of current demographic data collection and population surveillance efforts to include childhood skeletal cancers nationally;

(2) the development of a uniform reporting system under which treating physicians, hospitals, clinics, and states report the diagnosis of childhood skeletal cancers, including relevant associated epidemiological data; and

(3) support for the National Limb Loss Information Center to address, in part, the primary and secondary needs of persons who experience childhood skeletal cancers in order to prevent or minimize the disabling nature of these cancers.

(c) COORDINATION OF ACTIVITIES- The Secretary shall assure that activities under this section are coordinated as appropriate with other agencies of the Public Health Service that carry out activities focused on childhood cancers and limb loss.

(d) DEFINITION- For purposes of this section, the term `childhood skeletal cancer' refers to any malignancy originating in the connective tissue of a person before skeletal maturity including the appendicular and axial skeleton. The Secretary may revise the definition of such term as determined necessary to carry out the intent of this effort.

(e) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out this section, there are authorized to be appropriated such sums as may be necessary for each of the fiscal years 2000 through 2003.

Subtitle M--Reducing Burden of Diabetes Among Children and Youth

SEC. 291. PROGRAMS REGARDING DIABETES IN CHILDREN AND YOUTH.

(a) NATIONAL REGISTRY ON JUVENILE DIABETES- The Secretary of Health and Human Services (in this section referred to as the `Secretary'), acting through the Director of the Centers for Disease Control and Prevention, shall develop a system to collect data on juvenile diabetes, including with respect to incidence and prevalence, and shall establish a national database for such data.

(b) LONG-TERM EPIDEMIOLOGY STUDIES ON JUVENILE DIABETES-

(1) IN GENERAL- The Secretary, acting through the Director of the National Institutes of Health, shall conduct or support long-term epidemiology studies in which individuals with type 1, or juvenile, diabetes are followed for 10 years or more. Such studies shall, in order to provide a valuable resource for the purposes specified in paragraph (2), provide for complete characterization of disease manifestations, appropriate medical history, elucidation of environmental factors, delineation of complications, results of usual medical treatment and a variety of other potential valuable (such as samples of blood).

(2) PURPOSES- The purposes referred to in paragraph (1) with respect to type 1 diabetes are the following:

(A) Delineation of potential environmental triggers thought precipitating or causing type 1 diabetes.

(B) Delineation of those clinical characteristics or lab measures associated with complications of the disease.

(C) Potential study population to enter into clinical trials for prevention and treatment, as well as genetic studies.

(c) TYPE 2 DIABETES IN YOUTH- The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall implement a national public health effort to address type 2 diabetes in youth, including--

(1) enhancing surveillance systems and expanding research to better assess the prevalence of type 2 diabetes in youth and determine the extent to which type 2 diabetes is incorrectly diagnosed as type 1 diabetes among children; and

(2) assisting States in establishing coordinated school health programs and physical activity and nutrition demonstration programs to control weight and increase physical activity among youth.

(d) CLINICAL TRIAL INFRASTRUCTURE/INNOVATIVE TREATMENTS FOR JUVENILE DIABETES- The Secretary, acting through the Director of the National Institutes of Health, shall support regional clinical centers for the cure of juvenile diabetes and shall through such centers provide for--

(1) well-characterized population of children appropriate for study;

(2) well-trained clinical scientists able to conduct such trials;

(3) appropriate clinical settings able to house such studies; and

(4) appropriate statistical capability, data, safety and other monitoring capacity.

(e) DEVELOPMENT OF VACCINE- The Secretary, acting through the appropriate agencies of the Public Health Service, shall provide for a national effort to develop a vaccine for type 1 diabetes. Such effort shall provide for a combination of increased efforts in research and development of candidate vaccines, coupled with appropriate ability to conduct large clinical trials in children.

(f) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out this section, there are authorized to be appropriated such sums as may be necessary for each of the fiscal years 2000 through 2003.

Subtitle N--Miscellaneous Provisions

SEC. 296. REPORT REGARDING RESEARCH ON RARE DISEASES IN CHILDREN.

Not later than 180 days after the date of the enactment of this Act, the Director of the National Institutes of Health shall submit to the Congress a report on--

(1) the activities that, during fiscal year 1999, were conducted and supported by such Institutes with respect to rare diseases in children, including Friedreich's ataxia; and

(2) the activities that are planned to be conducted and supported by such Institutes with respect to such diseases during the fiscal years 2000 through 2003.

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