[DOCID: f:hr568.110]
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110th Congress Report
HOUSE OF REPRESENTATIVES
2d Session 110-568
======================================================================
WAKEFIELD ACT
_______
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. 2464]
[Including cost estimate of the Congressional Budget Office]
The Committee on Energy and Commerce, to whom was referred
the bill (H.R. 2464) to amend the Public Health Service Act to
provide a means for continued improvement in emergency medical
services for children, 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......................................................... 4
Committee Consideration.......................................... 4
Committee Votes.................................................. 4
Committee Oversight Findings..................................... 4
Statement of General Performance Goals and Objectives............ 4
New Budget Authority, Entitlement Authority, and Tax Expenditures 4
Earmarks and Tax and Tariff Benefits............................. 5
Committee Cost Estimate.......................................... 5
Congressional Budget Office Estimate............................. 5
Federal Mandates Statement....................................... 6
Advisory Committee Statement..................................... 6
Constitutional Authority Statement............................... 6
Applicability to Legislative Branch.............................. 6
Section-by-Section Analysis of the Legislation................... 6
Changes in Existing Law Made by the Bill, as Reported............ 7
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 ``Wakefield Act''.
SEC. 2. FINDINGS AND PURPOSE.
(a) Findings.--Congress makes the following findings:
(1) There are 31,000,000 child and adolescent visits to the
Nation's emergency departments every year.
(2) Over 90 percent of children requiring emergency care are
seen in general hospitals, not in free-standing children's
hospitals, with one-quarter to one-third of the patients being
children in the typical general hospital emergency department.
(3) Severe asthma and respiratory distress are the most
common emergencies for pediatric patients, representing nearly
one-third of all hospitalizations among children under the age
of 15 years, while seizures, shock, and airway obstruction are
other common pediatric emergencies, followed by cardiac arrest
and severe trauma.
(4) Up to 20 percent of children needing emergency care have
underlying medical conditions such as asthma, diabetes, sickle-
cell disease, low birth weight, and bronchopulmonary dysplasia.
(5) Significant gaps remain in emergency medical care
delivered to children. Only about 6 percent of hospitals have
available all the pediatric supplies deemed essential by the
American Academy of Pediatrics and the American College of
Emergency Physicians for managing pediatric emergencies, while
about half of hospitals have at least 85 percent of those
supplies.
(6) Providers must be educated and trained to manage
children's unique physical and psychological needs in emergency
situations, and emergency systems must be equipped with the
resources needed to care for this especially vulnerable
population.
(7) Systems of care must be continually maintained, updated,
and improved to ensure that research is translated into
practice, best practices are adopted, training is current, and
standards and protocols are appropriate.
(8) The Emergency Medical Services for Children (EMSC)
Program under section 1910 of the Public Health Service Act (42
U.S.C. 300w-9) is the only Federal program that focuses
specifically on improving the pediatric components of emergency
medical care.
(9) The EMSC Program promotes the nationwide exchange of
pediatric emergency medical care knowledge and collaboration by
those with an interest in such care and is depended upon by
Federal agencies and national organizations to ensure that this
exchange of knowledge and collaboration takes place.
(10) The EMSC Program also supports a multi-institutional
network for research in pediatric emergency medicine, thus
allowing providers to rely on evidence rather than anecdotal
experience when treating ill or injured children.
(11) The Institute of Medicine stated in its 2006 report,
``Emergency Care for Children: Growing Pains'', that the EMSC
Program ``boasts many accomplishments ... and the work of the
program continues to be relevant and vital''.
(12) The EMSC Program has proven effective over two decades
in driving key improvements in emergency medical services to
children, and should continue its mission to reduce child and
youth morbidity and mortality by supporting improvements in the
quality of all emergency medical and emergency surgical care
children receive.
(b) Purpose.--It is the purpose of this Act to reduce child and youth
morbidity and mortality by supporting improvements in the quality of
all emergency medical care children receive.
SEC. 3. REAUTHORIZATION OF EMERGENCY MEDICAL SERVICES FOR CHILDREN
PROGRAM.
Section 1910 of the Public Health Service Act (42 U.S.C. 300w-9) is
amended--
(1) in subsection (a), by striking ``3-year period (with an
optional 4th year'' and inserting ``4-year period (with an
optional 5th year'';
(2) in subsection (d)--
(A) by striking ``and such sums'' and inserting
``such sums''; and
(B) by inserting before the period the following: ``,
$25,000,000 for fiscal year 2009, $26,250,000 for
fiscal year 2010, $27,562,500 for fiscal year 2011,
$28,940,625 for fiscal year 2012, and $30,387,656 for
fiscal year 2013'';
(3) by redesignating subsections (b) through (d) as
subsections (c) through (e), respectively; and
(4) by inserting after subsection (a) the following:
``(b)(1) The purpose of the program established under this section is
to reduce child and youth morbidity and mortality by supporting
improvements in the quality of all emergency medical care children
receive, through the promotion of projects focused on the expansion and
improvement of such services, including those in rural areas and those
for children with special healthcare needs. In carrying out this
purpose, the Secretary shall support emergency medical services for
children by supporting projects that--
``(A) develop and present scientific evidence;
``(B) promote existing and innovative technologies
appropriate for the care of children; or
``(C) provide information on health outcomes and
effectiveness and cost-effectiveness.
``(2) The program established under this section shall--
``(A) strive to enhance the pediatric capability of emergency
medical service systems originally designed primarily for
adults; and
``(B) in order to avoid duplication and ensure that Federal
resources are used efficiently and effectively, be coordinated
with all research, evaluations, and awards related to emergency
medical services for children undertaken and supported by the
Federal Government.''.
Purpose and Summary
The purpose of H.R. 2464, the ``Wakefield Act'', is to
amend the Public Health Service Act to provide a means for
continued improvement in emergency medical services for
children.
Background and Need for Legislation
Each year, injury alone claims more lives of children
between the ages of 1 and 19 than do all forms of illness.
Although Early Emergency Medical Services (EMS) systems were
designed to provide rapid intervention for sudden cardiac
arrest in adults and rapid transport for motor vehicle crash
victims, there has been limited recognition that children
require specialized care. Although EMS systems and hospital
emergency departments are widely assumed to be equally capable
of caring for children and adults, in fact, in many EMS
systems, children's needs have been overlooked as services were
developed for adult trauma and cardiac patients.
H.R. 2464 reauthorizes the Emergency Medical Services for
Children (EMSC) program within the U.S. Department of Health
and Human Services (HHS). The EMSC program began in 1984 and is
designed to ensure state-of-the-art emergency medical care for
ill or injured children and adolescents. It covers the entire
spectrum of emergency medical care. The EMSC program provides
grants to States to improve existing EMS systems and to schools
of medicine to develop and evaluate improved procedures and
protocols for treating children.
Since its establishment more than 20 years ago, the EMSC
program has driven major improvements in emergency care for
children. Injury-related deaths among children have dropped by
40 percent over that period. Enormous strides have been made in
areas such as ensuring that all ambulances carry appropriate
pediatric equipment and supplies, establishing transfer
protocols to assure that severely injured children are sent to
the facilities best able to care for them, and collecting and
analyzing data on pediatric emergency care to inform future
efforts towards improvement.
Although much progress has been achieved, more remains to
be done. The EMSC program's authorization expired in September
2005, and there are numerous important improvements that can be
made to the program.
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. 2464,
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. 2464 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. 2464 reported to the House. A motion by Mr.
Dingell to order H.R. 2464 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. 2464 are reflected in this report.
Statement of General Performance Goals and Objectives
The objective of H.R. 2464 is to extend by one year the
length of time for which a grant may be awarded under the EMSC
grant program, which allows the Secretary of HHS to make grants
to States or schools of medicine to support projects to expand
and improve EMS for children who need treatment for trauma or
critical care. Furthermore, H.R. 2464 sets forth as the purpose
of the program the reduction of child and youth morbidity and
mortality by supporting improvements in the quality of all
emergency medical care children receive. H.R. 2464 requires the
Secretary of HHS to support emergency medical services for
children by supporting projects that: (1) develop and present
scientific evidence; (2) promote existing innovative
technologies appropriate for the care of children; and (3)
provide information on health outcomes and effectiveness and
cost-effectiveness. Lastly, H.R. 2464 states that the EMSC
program shall strive to enhance the pediatric capability of EMS
systems and must be coordinated with all research, evaluations,
and awards undertaken by the Federal Government related to EMS
for children.
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. 2464 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. 2464 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.
2464 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. 2464 provided by the Congressional Budget Office pursuant
to section 402 of the Congressional Budget Act of 1974:
April 4, 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. 2464, the
Wakefield Act.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Mindy Cohen.
Sincerely,
Robert A. Sunshine
(For Peter R. Orszag.)
Enclosure.
H.R. 2464--Wakefield Act
H.R. 2464 would amend the Public Health Service Act to
direct the Secretary of Health and Human Services to provide
grants to states and medical schools for several activities
intended to reduce child and youth morbidity and mortality by
improving emergency medical services for children.
The bill would authorize the appropriation of $25 million
for 2009 and $138 million over the 2009-2013 period for those
purposes. Based on historical patterns of spending for similar
activities, CBO estimates that implementing H.R. 2464 would
cost $4 million in 2009 and $93 million over the 2009-2013
period, assuming appropriation of the specified amounts.
Enacting H.R. 2464 would have no effect on direct spending or
revenues.
H.R. 2464 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act.
The estimated budgetary impact of H.R 2464 is shown in the
following table. 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
Authorization Level............. 25 26 28 29 30
Estimated Outlays............... 4 15 23 27 24
------------------------------------------------------------------------
The CBO staff contact for this estimate is Mindy Cohen.
This estimate was 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. 2464 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.
2464.
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. 2464 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. 2464 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
``Wakefield Act''.
Section 2. Findings and purpose
Section 2 states the Congressional findings.
Section 3. Reauthorization of emergency medical services for children
program
Section 3 of this legislation amends Section 1910 of the
Public Health Service Act (42 U.S.C. 300w-9).
Section 3 extends, by 1 year, the length of time for which
a grant may be awarded under the EMSC program. The Secretary of
HHS awards these grants to States or schools of medicine to
support projects to expand and improve emergency medical
services for children who need treatment for trauma or critical
care.
Section 3 sets forth as the purpose of the program the
reduction of child and youth morbidity and mortality by
supporting improvements in the quality of all emergency medical
care children receive.
Section 3 requires that the Secretary of HHS support
emergency medical services for children by supporting projects
that develop and present scientific evidence, which promote
existing innovative technologies appropriate for the care of
children, and which provide information on health outcomes,
effectiveness, and cost-effectiveness.
Section 3 states that the EMSC program shall strive to
enhance the pediatric capability of EMS systems and, in order
to avoid duplication, coordinate with all research,
evaluations, and awards undertaken by the Federal Government
related to EMS for children.
Finally, Section 3 amends the authorization of
appropriations for the EMSC program. H.R. 2464 changes ``such
sums'' to $25,000,000 for fiscal year 2009, $26,250,000 for
fiscal year 2010, $27,562,500 for fiscal year 2011, $28,940,625
for fiscal year 2012, and $30,387,656 for fiscal year 2013.
This change provides a 5 percent increase in authorizations for
each fiscal year.
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 XIX--BLOCK GRANTS
Part A--Preventive Health and Health Services Block Grant
* * * * * * *
EMERGENCY MEDICAL SERVICES FOR CHILDREN
Sec. 1910. (a) For activities in addition to the activities
which may be carried out by States under section 1904(a)(1)(F),
the Secretary may make grants to States or accredited schools
of medicine in States to support a program of demonstration
projects for the expansion and improvement of emergency medical
services for children who need treatment for trauma or critical
care. Any grant made under this subsection shall be for not
more than a [3-year period (with an optional 4th year] 4-year
period (with an optional 5th year based on performance),
subject to annual evaluation by the Secretary. Only 3 grants
under this subsection may be made in a State (to a State or to
a school of medicine in such State) in any fiscal year.
(b)(1) The purpose of the program established under this
section is to reduce child and youth morbidity and mortality by
supporting improvements in the quality of all emergency medical
care children receive, through the promotion of projects
focused on the expansion and improvement of such services,
including those in rural areas and those for children with
special healthcare needs. In carrying out this purpose, the
Secretary shall support emergency medical services for children
by supporting projects that--
(A) develop and present scientific evidence;
(B) promote existing and innovative technologies
appropriate for the care of children; or
(C) provide information on health outcomes and
effectiveness and cost-effectiveness.
(2) The program established under this section shall--
(A) strive to enhance the pediatric capability of
emergency medical service systems originally designed
primarily for adults; and
(B) in order to avoid duplication and ensure that
Federal resources are used efficiently and effectively,
be coordinated with all research, evaluations, and
awards related to emergency medical services for
children undertaken and supported by the Federal
Government.
[(b)] (c) The Secretary may renew a grant made under
subsection (a) for one additional one-year period only if the
Secretary determines that renewal of such grant will provide
significant benefits through the collection, analysis, and
dissemination of information or data which will be useful to
States in which grants under such subsection have not been
made.
[(c)] (d) For purposes of this section--
(1) * * *
* * * * * * *
[(d)] (e) To carry out this section, there are authorized to
be appropriated $2,000,000 for fiscal year 1985 and for each of
the two succeeding fiscal years, $3,000,000 for fiscal year
1989, $4,000,000 for fiscal year 1990, $5,000,000 for each of
the fiscal years 1991 and 1992, [and such sums] such sums as
may be necessary for each of the fiscal years 1993 through
2005, $25,000,000 for fiscal year 2009, $26,250,000 for fiscal
year 2010, $27,562,500 for fiscal year 2011, $28,940,625 for
fiscal year 2012, and $30,387,656 for fiscal year 2013.
* * * * * * *
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