[DOCID: f:hr565.110]
From the House Reports Online via GPO Access
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110th Congress Report
HOUSE OF REPRESENTATIVES
2d Session 110-565
======================================================================
EARLY HEARING DETECTION AND INTERVENTION ACT OF 2008
_______
April 8, 2008.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Dingell, from the Committee on Energy and Commerce, submitted the
following
R E P O R T
[To accompany H.R. 1198]
[Including cost estimate of the Congressional Budget Office]
The Committee on Energy and Commerce, to whom was referred
the bill (H.R. 1198) to amend the Public Health Service Act
regarding early detection, diagnosis, and treatment of hearing
loss, having considered the same, report favorably thereon with
an amendment and recommend that the bill as amended do pass.
CONTENTS
Page
Amendment........................................................ 1
Purpose and Summary.............................................. 3
Background and Need for Legislation.............................. 3
Hearings......................................................... 3
Committee Consideration.......................................... 3
Committee Votes.................................................. 4
Committee Oversight Findings..................................... 4
Statement of General Performance Goals and Objectives............ 4
New Budget Authority, Entitlement Authority, and Tax Expenditures 4
Earmarks and Tax and Tariff Benefits............................. 4
Committee Cost Estimate.......................................... 5
Congressional Budget Office Estimate............................. 5
Federal Mandates Statement....................................... 7
Advisory Committee Statement..................................... 7
Constitutional Authority 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
Amendment
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 ``Early Hearing Detection and
Intervention Act of 2008''.
SEC. 2. EARLY DETECTION, DIAGNOSIS, AND TREATMENT OF HEARING LOSS.
Section 399M of the Public Health Service Act (42 U.S.C. 280g-1) is
amended--
(1) in the section heading, by striking ``INFANTS'' and
inserting ``NEWBORNS AND INFANTS'';
(2) in subsection (a)--
(A) in the matter preceding paragraph (1), by
striking ``screening, evaluation and intervention
programs and systems'' and inserting ``screening,
evaluation, diagnosis, and intervention programs and
systems, and to assist in the recruitment, retention,
education, and training of qualified personnel and
health care providers,'';
(B) by amending paragraph (1) to read as follows:
``(1) To develop and monitor the efficacy of statewide
programs and systems for hearing screening of newborns and
infants; prompt evaluation and diagnosis of children referred
from screening programs; and appropriate educational,
audiological, and medical interventions for children identified
with hearing loss. Early intervention includes referral to and
delivery of information and services by 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. Programs and systems under
this paragraph shall establish and foster family-to-family
support mechanisms that are critical in the first months after
a child is identified with hearing loss.''; and
(C) by adding at the end the following:
``(3) To develop efficient models to ensure that newborns and
infants who are identified with a hearing loss through
screening receive follow-up by a qualified health care
provider. These models shall be evaluated for their
effectiveness, and State agencies shall be encouraged to adopt
models that effectively increase the rate of occurrence of such
follow-up.
``(4) To ensure an adequate supply of qualified personnel to
meet the screening, evaluation, diagnosis, and early
intervention needs of children.'';
(3) in subsection (b)--
(A) in paragraph (1)(A), by striking ``hearing loss
screening, evaluation, and intervention programs'' and
inserting ``hearing loss screening, evaluation,
diagnosis, and intervention programs''; and
(B) in paragraph (2)--
(i) by striking ``for purposes of this
section, continue'' and insert the following:
``for purposes of this section--
``(A) continue'';
(ii) by striking the period at the end and
inserting ``; and''; and
(iii) by adding at the end the following:
``(B) establish a postdoctoral fellowship program to
foster research and development in the area of early
hearing detection and intervention.'';
(4) in paragraphs (2) and (3) of subsection (c), by striking
the term ``hearing screening, evaluation and intervention
programs'' each place such term appears and inserting ``hearing
screening, evaluation, diagnosis, and intervention programs'';
(5) in subsection (e)--
(A) in paragraph (3), by striking ``ensuring that
families of the child'' and all that follows and
inserting ``ensuring that families of the child are
provided comprehensive, consumer-oriented information
about the full range of family support, training,
information services, and language and communication
options and are given the opportunity to consider and
obtain the full range of such appropriate services,
educational and program placements, and other options
for their child from highly qualified providers.''; and
(B) in paragraph (6), by striking ``, after
rescreening,''; and
(6) in subsection (f)--
(A) in paragraph (1), by striking ``fiscal year
2002'' and inserting ``fiscal years 2009 through
2014'';
(B) in paragraph (2), by striking ``fiscal year
2002'' and inserting ``fiscal years 2009 through
2014''; and
(C) in paragraph (3), by striking ``fiscal year
2002'' and inserting ``fiscal years 2009 through
2014''.
Purpose and Summary
The purpose of H.R. 1198, the Early Hearing Detection and
Intervention Act of 2008, is to amend the Public Health Service
Act to establish grant programs to provide for education and
outreach on newborn screening and coordinated follow-up care
once newborn screening has been conducted, to reauthorize
programs under part A of title XI of such act, and for other
purposes.
Background and Need for Legislation
Each year in the United States, more than 12,000 babies are
born with hearing loss. The cause of hearing loss for many
babies is not known, and hearing loss can go undetected for
years. Studies have shown that children who have hearing loss
can have delays in speech, language, and cognitive development.
When a child's hearing loss is identified soon after birth, the
child's family and doctors can make sure the child gets
services (e.g., intervention) he or she needs at an early age,
increasing the likelihood of mitigating or preventing those
delays.
H.R. 1198 reauthorizes the Early Hearing Detection and
Intervention (EHDI) program within the U.S. Department of
Health and Human Services (HHS). The original legislation,
which was enacted in 2000, directed Federal agencies to work
with States to develop newborn infant hearing screening and
early intervention programs. EHDI programs include screening
(the initial test of infants for hearing loss), diagnostic
evaluations (to confirm hearing loss), and early intervention
(including medical services, early intervention programs, and
family support) to enhance language, communication, and
cognitive and social skill development.
When the EHDI program was first implemented, 44 percent of
newborns were screened for hearing loss. With increased
Congressional funding, this increased to 67 percent by the end
of 2001, and 87 percent by the end of 2002. Today, more than 93
percent of all newborns are screened, and each year there are
thousands of infants with hearing loss who benefit from early
identification.
Despite the success of the EHDI program, much work remains
to be done. Many infants do not receive timely follow-up and
referrals due to shortages in properly trained healthcare
providers, limited access to early intervention programs, and
poor EHDI program integration with existing public healthcare
systems.
Hearings
There were no hearings held in connection to the bill
reported by the Committee.
Committee Consideration
On Tuesday, March 11, 2008, the Subcommittee on Health met
in open markup session and favorably forwarded H.R. 1198,
amended, to the full Committee for consideration, by a voice
vote. On Thursday, March 13, 2008, the full Committee met in
open markup session and ordered H.R. 1198 favorably reported to
the House, as amended by the Subcommittee on Health, by a voice
vote. No amendments were offered during full Committee
consideration.
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 on amendments or in connection
with ordering H.R. 1198 reported to the House. A motion by Mr.
Dingell to order H.R. 1198 favorably reported to the House, as
amended, was agreed to by a voice vote.
Committee Oversight Findings
Regarding clause 3(c)(1) of rule XIII of the Rules of the
House of Representatives, the oversight findings of the
Committee regarding H.R. 1198 are reflected in this report.
Statement of General Performance Goals and Objectives
The objective of H.R. 1198 is to expand the EHDI program to
include diagnostic services among services provided and to
require the Secretary of HHS, acting through the Administrator
of the Health Resources and Services Administration (HRSA), to
assist in the recruitment, retention, education, and training
of qualified personnel and healthcare providers. Within the
purposes section of the EHDI program, H.R. 1198 states that the
Secretary of HHS, acting through the Administrator of HRSA,
shall make awards of grants for the purpose of developing
efficient models to ensure that newborns, infants, and young
children who are identified with a hearing loss through
screening are not lost to follow-up by a qualified healthcare
provider and for the purpose of ensuring an adequate supply of
qualified personnel to meet the screening, evaluation, and
early intervention needs of children. H.R. 1198 requires the
Director of the National Institutes of Health (NIH), acting
through the Director of the National Institute on Deafness and
Other Communication Disorders (NIDOCD), to establish a
postdoctoral fellowship program to foster research and
development in the area of early hearing detection and
intervention. In conclusion, H.R. 1198 amends the definition of
``early intervention'' to require that families be given the
opportunity to obtain the full range of early intervention
services, educational and program placements, and other options
for their child from highly qualified providers.
New Budget Authority, Entitlement Authority, and Tax Expenditures
Regarding compliance with clause 3(c)(2) of rule XIII of
the Rules of the House of Representatives, the Committee finds
that H.R. 1198 would result in no new or increased budget
authority, entitlement authority, or tax expenditures or
revenues.
Earmarks and Tax and Tariff Benefits
Regarding compliance with clause 9 of rule XXI of the Rules
of the House of Representatives, H.R. 1198 does not contain any
congressional earmarks, limited tax benefits, or limited tariff
benefits as defined in clause 9(d), 9(e), or 9(f) of rule XXI.
Committee Cost Estimate
The Committee adopts as its own the cost estimate on H.R.
1198 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 on
H.R. 1198 provided by the Congressional Budget Office pursuant
to section 402 of the Congressional Budget Act of 1974:
April 7, 2008.
Hon. John D. Dingell,
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. 1198, the Early
Hearing Detection and Intervention Act of 2008.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contacts are Sarah
Evans, Tim Gronniger, and Lara Robillard.
Sincerely,
Robert A. Sunshine
(For Peter R. Orszag, Director).
Enclosure.
H.R. 1198--Early Hearing Detection and Intervention Act of 2008
Summary: H.R. 1198 would amend the Public Health Service
Act to authorize and expand research and public health
activities related to the early detection, diagnosis, and
treatment of hearing loss in newborns and infants. CBO
estimates that implementing the bill would cost $183 million
over the 2009-2013 period, subject to the appropriation of the
necessary amounts. Enacting H.R. 1198 would not affect direct
spending or federal revenues.
H.R. 1198 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 impact of H.R. 1198 is shown in the following table.
The costs of this legislation fall within budget function 550
(health).
Basis of estimate: H.R. 1198 would authorize funding for
early hearing loss detection and intervention activities at the
Health Resources and Services Administration (HRSA), the
Centers for Disease Control and Prevention (CDC), and the
National Institutes of Health (NIH) for fiscal years 2009
through 2014. It also would require the Director of the
National Institutes of Health to establish a postdoctoral
research program to foster research and development in the area
of early hearing detection and intervention. CBO estimates that
those activities would require the appropriation of $222
million over the 2009-2013 period. Based on historical spending
patterns for similar activities and assuming the appropriation
of necessary amounts, CBO estimates that implementing H.R. 1198
would cost $183 million over the 2009-2013 period. The costs of
this legislation fall within budget function 550 (health).
------------------------------------------------------------------------
By fiscal year, in millions of
dollars--
---------------------------------------
2009 2010 2011 2012 2013
------------------------------------------------------------------------
CHANGES IN SPENDING SUBJECT TO APPROPRIATION
HRSA:
Estimated Authorization 12 12 13 13 13
Level......................
Estimated Outlays........... 6 11 12 13 13
CDC:
Estimated Authorization 10 10 11 11 11
Level......................
Estimated Outlays........... 4 9 10 10 11
NIH
Estimated Authorization 20 21 21 22 22
Level......................
Estimated Outlays........... 5 17 20 21 21
Total Changes
Estimated Authorization 45 43 45 46 46
Level......................
Estimated Outlays........... 15 37 42 44 45
------------------------------------------------------------------------
Note: CDC = Centers for Disease and Prevention; HRSA = Health Resources
and Services Administration; NIH = National Institutes of Health.
HRSA administers the Universal Newborn Screening program,
which makes grants to states to support testing of infants
prior to hospital discharge, audiologic evaluation by three
months of age, and early intervention activities. CBO estimates
that those activities would require the appropriation of $63
million over the 2009-2013 period. Assuming the appropriation
of estimated amounts, CBO estimates that implementing H.R. 1198
would cost $55 million over the 2009-2013 period.
H.R. 1198 would authorize CDC to make grants to states and
provide technical assistance to states to promote screening,
surveillance, and research into the causes of hearing loss
among newborns and infants. CBO estimates that the CDC would
require the appropriation of $53 million over the 2009-2013
period to conduct the authorized activities. CBO estimates that
implementing those programs would cost $44 million over the
2009-2013 period, assuming the appropriation of the estimated
amounts.
H.R. 1198 would authorize the NIH to conduct research on
early detection and treatment of hearing loss. The bill also
would direct NIH to establish a postdoctoral fellowship program
to train researchers in the field of detecting and intervening
in early hearing loss. Based on information provided by NIH,
CBO expects that the new postdoctoral program would fund two to
three postdoctoral fellows at approximately $50,000 per year.
Based on that information, historical program expenditures at
NIH, and adjustments for inflation, CBO estimates that NIH
would require the appropriation of $106 million over the 2009-
2013 period to conduct the authorized activities. CBO estimates
that implementing those programs would cost $84 million over
the 2009-2013 period, assuming appropriation of the estimated
amounts.
Intergovernmental and private-sector impact: H.R. 1198
contains no intergovernmental or private-sector mandates as
defined in UMRA. States that participate in programs to detect,
diagnose, and treat hearing loss in newborns and infants would
benefit from activities authorized in the bill.
Estimate prepared by: Federal Costs: Sarah Evans, Tim
Gronniger, and Lara Robillard; Impact on State, Local, and
Tribal Governments: Lisa Ramirez-Branum; Impact on the Private
Sector: Patrick Bernhardt.
Estimate approved by: Keith J. Fontenot, Deputy Assistant
Director for Health and Human Resources, Budget Analysis
Division.
Federal Mandates Statement
The Committee adopts as its own the estimate of Federal
mandates regarding H.R. 1198 prepared by the Director of the
Congressional Budget Office pursuant to section 423 of the
Unfunded Mandates Reform Act.
Advisory Committee Statement
No advisory committees within the meaning of section 5(b)
of the Federal Advisory Committee Act would be created by H.R.
1198.
Constitutional Authority Statement
Pursuant to clause 3(d)(1) of rule XIII of the Rules of the
House of Representatives, the Committee finds that the
Constitutional authority for H.R. 1198 is provided in the
provisions of Article I, section 8, clause 1, that relate to
expending funds to provide for the general welfare of the
United States.
Applicability to Legislative Branch
The Committee finds that H.R. 1198 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 of 1995.
Section-by-Section Analysis of the Legislation
Section 1. Short title
Section 1 establishes the short title of the Act as the
``Early Hearing Detection and Intervention Act of 2008''.
Section 2. Early detection, diagnosis, and treatment of hearing loss
Section 2 of this legislation amends Section 399M of the
Public Health Service Act (42 U.S.C. 280g-1). In the Section
399M heading, H.R. 1198 strikes ``infants'' and inserts
``newborns and infants.''
Section 2 expands the purpose of the grant program to say
that grants and cooperative agreements will be given to (1)
develop statewide newborn, infant hearing screening,
evaluation, diagnosis, and intervention programs and systems;
(2) assist in the recruitment, retention, education, and
training of qualified personnel and healthcare providers; (3)
ensure the prompt evaluation of children referred from
screening programs; (4) provide appropriate educational,
audiological, and medical interventions for children identified
with hearing loss; (5) establish and foster family-to-family
support mechanisms; (6) develop efficient models to ensure that
newborns and infants who are identified with a hearing loss
through screening receive follow-up by a qualified health care
provider; and (7) ensure an adequate supply of qualified
personnel to meet the screening, evaluation, diagnosis, and
early intervention needs of children.
Section 2 directs the Director of the NIH, acting through
the Director of NIDOCD, to establish a postdoctoral fellowship
program to foster research and development in the area of early
hearing detection and intervention.
Section 2 amends the definition of the term ``early
intervention.'' As amended by H.R. 1198, the term ``early
intervention'' ensures that families of the child are provided
comprehensive, consumer-oriented information about the full
range of family support, training, information services, and
language and communication options and are given the
opportunity to consider and obtain the full range of such
appropriate services, educational and program placements, and
other options for their child from highly qualified providers.
Finally, Section 2 updates the authorization of
appropriation sections to strike ``fiscal year 2002''
everywhere that such term appears and replace it with ``fiscal
years 2009 through 2014.''
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, 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 P--ADDITIONAL PROGRAMS
* * * * * * *
SEC. 399M. EARLY DETECTION, DIAGNOSIS, AND TREATMENT REGARDING HEARING
LOSS IN [INFANTS] NEWBORNS AND INFANTS.
(a) Statewide Newborn and Infant Hearing Screening,
Evaluation and Intervention Programs and Systems.--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] screening, evaluation, diagnosis, and
intervention programs and systems, and to assist in the
recruitment, retention, education, and training of qualified
personnel and health care providers, 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.]
(1) To develop and monitor the efficacy of statewide
programs and systems for hearing screening of newborns
and infants; prompt evaluation and diagnosis of
children referred from screening programs; and
appropriate educational, audiological, and medical
interventions for children identified with hearing
loss. Early intervention includes referral to and
delivery of information and services by 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. Programs and systems under this
paragraph shall establish and foster family-to-family
support mechanisms that are critical in the first
months after a child is identified with hearing loss.
* * * * * * *
(3) To develop efficient models to ensure that
newborns and infants who are identified with a hearing
loss through screening receive follow-up by a qualified
health care provider. These models shall be evaluated
for their effectiveness, and State agencies shall be
encouraged to adopt models that effectively increase
the rate of occurrence of such follow-up.
(4) To ensure an adequate supply of qualified
personnel to meet the screening, evaluation, diagnosis,
and early intervention needs of children.
(b) 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] hearing loss
screening, evaluation, diagnosis, and
intervention programs and systems;
* * * * * * *
(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] for purposes of this section--
(A) 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[.]; and
(B) establish a postdoctoral fellowship
program to foster research and development in
the area of early hearing detection and
intervention.
(c) Coordination and Collaboration.--
(1) * * *
(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] hearing screening, evaluation,
diagnosis, 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] hearing screening, evaluation,
diagnosis, and intervention programs and systems under
subsection (a) and to develop a data collection system
under subsection (b).
* * * * * * *
(e) Definitions.--For purposes of this section:
(1) * * *
* * * * * * *
(3) The term ``early intervention'' refers to
providing appropriate services for the child with
hearing loss, including nonmedical services, 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.]
ensuring that families of the child are provided
comprehensive, consumer-oriented information about the
full range of family support, training, information
services, and language and communication options and
are given the opportunity to consider and obtain the
full range of such appropriate services, educational
and program placements, and other options for their
child from highly qualified providers.
* * * * * * *
(6) The term ``newborn and infant hearing screening''
refers to objective physiologic procedures to detect
possible hearing loss and to identify newborns and
infants who[, after rescreening,] require further
audiologic and medical evaluations.
(f) Authorization of Appropriations.--
(1) Statewide newborn and infant hearing screening,
evaluation and intervention programs and systems.--For
the purpose of carrying out subsection (a), there are
authorized to be appropriated to the Health Resources
and Services Administration such sums as may be
necessary for [fiscal year 2002] fiscal years 2009
through 2014.
(2) Technical assistance, data management, and
applied research; centers for disease control and
prevention.--For the purpose of carrying out subsection
(b)(1), there are authorized to be appropriated to the
Centers for Disease Control and Prevention such sums as
may be necessary for [fiscal year 2002] fiscal years
2009 through 2014.
(3) Technical assistance, data management, and
applied research; national institute on deafness and
other communication disorders.--For the purpose of
carrying out subsection (b)(2), there are authorized to
be appropriated to the National Institute on Deafness
and Other Communication Disorders such sums as may be
necessary for [fiscal year 2002] fiscal years 2009
through 2014.
* * * * * * *
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