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111th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 1st Session                                                     111-43

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



 
                             WAKEFIELD ACT

                                _______
                                

 March 23, 2009.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

 Mr. Waxman, from the Committee on Energy and Commerce, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 479]

      [Including cost estimate of the Congressional Budget Office]

  The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 479) 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.

    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 is celebrating its 25th anniversary, marking 
a quarter-century of 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 2010, $26,250,000 for fiscal year 2011, $27,562,500 for 
fiscal year 2012, $28,940,625 for fiscal year 2013, and $30,387,656 for 
fiscal year 2014'';
    (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 health care 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.''.

                                CONTENTS

                                                                   Page
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..........................................     4
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
Explanation of Amendments........................................     7
Changes in Existing Law Made by the Bill, As Reported............     7

                          Purpose and Summary

    The purpose of H.R. 479, the ``Wakefield Act'', is to amend 
the Public Health Service Act to provide a means for continued 
improvement in emergency medical services for children. The 
bill revises and extends the authorization for the Emergency 
Medicaid Services for Children program for the 5-year period FY 
2010 through FY 2014. The amounts authorized to be appropriated 
for this program are $25 million in FY 2010 and $138.14 million 
over 5 years.

                  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. In many EMS systems, children's needs 
were overlooked as services were developed for adult trauma and 
cardiac patients.
    The Emergency Medical Services for Children (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 25 years ago, the EMSC 
program has driven major improvements in emergency care for 
children. Injury-related deaths among children have dropped by 
40% over that period.
    Although much progress has been achieved, more remains to 
be done. The EMSC program's authorization expired in September 
2005.

                                Hearings

    The Committee on Energy and Commerce did not hold hearings 
on the legislation.

                        Committee Consideration

    The Committee on Energy and Commerce met in open markup 
session on Wednesday, March 4, 2009, and, pursuant to a motion 
by Mr. Waxman, agreed by unanimous consent to consider and 
approve H.R. 479 and several other bills en bloc. H.R. 479 was 
ordered favorably reported, amended, to the House by a voice 
vote. A manager's amendment to H.R. 479 offered by Mr. Waxman 
was adopted by unanimous consent.

                            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 recorded votes taken during consideration or 
ordering H.R. 479 reported to the House.

                      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 are reflected in this report.

         Statement of General Performance Goals and Objectives

    The objective of H.R. 479 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 Health and Human 
Services (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. 
479 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. 479 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. 
479 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. 479 would result in no new or increased budget 
authority, entitlement authority, or tax expenditures or 
revenues.

                  Earmarks and Tax and Tariff Benefits

    In compliance with clause 9 of rule XXI of the Rules of the 
House of Representatives, H.R. 479 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. 
479 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. 479 provided by the Congressional Budget Office pursuant 
to section 402 of the Congressional Budget Act of 1974:

                                     U.S. Congress,
                               Congressional Budget Office,
                                     Washington DC, March 18, 2009.
Hon. Henry A. Waxman,
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. 479, the Wakefield 
Act.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Lisa Ramirez-
Branum.
            Sincerely,
                                      Douglas W. Elmendorf,
                                                          Director.
    Enclosure.

H.R. 479--Wakefield Act

    H.R. 479 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 morbidity and mortality by improving 
emergency medical services for children.
    The bill would authorize the appropriation of $25 million 
for 2010 and $138 million over the 2010-2014 period for those 
purposes. Based on historical patterns of spending for similar 
activities, CBO estimates that implementing H.R. 479 would cost 
$4 million in 2010 and $96 million over the 2010-2014 period, 
assuming appropriation of the specified amounts. Enacting H.R. 
479 would have no effect on direct spending or revenues.
    H.R. 479 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act.
    The estimated budgetary impact of H.R. 479 is shown in the 
following table. The costs of the legislation fall within 
budget function 550 (health).


----------------------------------------------------------------------------------------------------------------
                                                                    By fiscal year, in millions of dollars--
                                                              --------------------------------------------------
                                                                2010    2011    2012    2013    2014   2010-2014
----------------------------------------------------------------------------------------------------------------
                                  CHANGES IN SPENDING SUBJECT TO APPROPRIATION

Authorization Level..........................................      25      26      28      29      30       138
Estimated Outlays............................................       4      15      23      27      28        96
----------------------------------------------------------------------------------------------------------------

    The CBO staff contact for this estimate is Lisa Ramirez-
Branum. This estimate was approved by Peter H. Fontaine, 
Assistant Director for Budget Analysis.

                       Federal Mandates Statement

    The Committee adopts as its own the estimate of federal 
mandates regarding H.R. 479 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 were created by H.R. 479.

                   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. 479 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. 479 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 promotes 
existing innovative technologies appropriate for the care of 
children and which provides 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. 479 changes ``and 
such sums'' to ``such sums'' and inserts ``$25,000,000 for 
fiscal year 2010, $26,250,000 for fiscal year 2011, $27,562,500 
for fiscal year 2012, $28,940,625 for fiscal year 2013, and 
$30,387,656 for fiscal year 2014''.

                       Explanation of Amendments

    Mr. Waxman offered a manager's amendment to restore certain 
provisions to H.R. 479 that had appeared in H.R. 2464 in the 
110th Congress. These include certain program requirements as 
well as requirements regarding how the Secretary will, through 
projects the Department funds, support emergency medical 
services for children.

         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 health care 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 2010, $26,250,000 for fiscal 
year 2011, $27,562,500 for fiscal year 2012, $28,940,625 for 
fiscal year 2013, and $30,387,656 for fiscal year 2014.

           *       *       *       *       *       *       *