H.R. 1244 — Healthy Beginnings Act of 1991

 
HR 1244 IH
102d CONGRESS
1st Session
 H. R. 1244
To amend the Public Health Service Act to establish a program of grants
to reduce the incidence of infant mortality and provide for the well-being
of mothers and their infants through the provision of certain services in
the home.
IN THE HOUSE OF REPRESENTATIVES
March 5, 1991
Mr. KENNEDY introduced the following bill; which was referred to the Committee
on Energy and Commerce
A BILL
To amend the Public Health Service Act to establish a program of grants
to reduce the incidence of infant mortality and provide for the well-being
of mothers and their infants through the provision of certain services in
the home.
  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 `Healthy Beginnings Act of 1991'.
SEC. 2. FINDINGS.
  The Congress finds as follows:
  (1) The annual nationwide costs of care for low-birthweight babies in
  neonatal intensive care is approximately $1,500,000,000.
  (2) The aggregate public costs under the programs Aid to Families With
  Dependent Children, Medicaid, and Food Stamps in 1988 for families in which
  the first birth occurred when the mother was a teen has been estimated
  at $19,830,000,000.
  (3) The aggregate public costs in 1983 of providing medical care, special
  education, and foster care in newly reported cases of child abuse has
  been estimated at $487,000,000. Since 1983 the average, annual number of
  reported cases is estimated to have increased by 47 percent.
  (4) The incidence of infant mortality can be reduced, and the well-being
  of mothers and their young children can be increased, through the provision
  in the home of certain health-related services.
  (5) One study reported that home visits to provide such services on behalf
  of a child through age 4 resulted in a public savings of $3,000 as compared
  to a child on behalf of whom such home visits have not been made during
  the comparable period.
  (6) In a study of low-income unmarried teen mothers, it was reported that,
  in a control group not receiving such home visits, 19 percent of the teens
  neglected or abused their child after birth, while in a group receiving
  the home visits, 4 percent of the teens engaged in such neglect or abuse.
  (7) In a study of mothers whose age was between 14 and 16 years of age
  (inclusive), the birthweight of infants whose mother received such home
  visits exceeded by an average of 1 pound the birthweight of infants whose
  mother did not receive the visits.
  (8) In a study of mothers who did not graduate from high school, the mother
  who received such home visits were twice as likely as the mothers of a
  control group that did not receive the visits to graduate from high school or
  enroll in an alternative educational program within 6 months of giving birth.
  (9) Four years after giving birth, one study found that low-income unmarried
  mothers who received home visits had 43 percent less unintended pregnancies
  than a control group that did not receive home visits.
  (10) In a study of low-income unmarried mothers over age 19, mothers
  receiving such home visits were employed an average of 16.4 months during the
  4 years following the birth of the first child, while the women in a control
  group that did not receive the visits were employed an average of 7.1 months.
SEC. 3. ESTABLISHMENT OF PROGRAM REGARDING HEALTHY BEGINNINGS CENTERS.
  Part D of title III of the Public Health Service Act (42 U.S.C. 254b et
  seq.), as amended by section 3 of Public Law 101-527 (104 Stat. 2314),
  is amended by adding at the end the following new subpart:
`Subpart VII--Home Health Services Regarding Young Children
`HOME HEALTH SERVICES REGARDING YOUNG CHILDREN
  `SEC. 340B. (a) GRANTS FOR HEALTHY BEGINNINGS CENTERS- The Secretary may
  make grants to public and nonprofit private entities for the purpose of
  reducing the incidence of infant mortality and providing for the well-being
  of mothers and their young children through the provision, in the home,
  of the services specified in subsection (d), as applicable--
  `(1) to pregnant women;
  `(2) to children who are not more than 2 years of age; and
  `(3) to the mothers of such children.
  `(b) REQUIREMENT REGARDING SERVICE TO MEDICALLY UNDERSERVED POPULATIONS-
  The Secretary may not make a grant under subsection (a) unless the
  applicant for the grant agrees to provide services under subsection (d)
  in a geographic area whose population is a medically underserved population.
  `(c) PREFERENCES IN MAKING GRANTS- In making grants under subsection
  (a), the Secretary shall give preference to migrant health centers and to
  community health centers.
  `(d) DESCRIPTION OF SERVICES- The services referred to in subsection
  (a) are--
  `(1) prenatal and postnatal health care;
  `(2) primary health care for eligible young children;
  `(3) educating eligible women in parenting skills;
  `(4) educating such women on the health consequences of smoking tobacco
  products and of consuming alcoholic beverages;
  `(5) educating such women on the proper use of nonprescription drugs;
  `(6) educating such women on family planning;
  `(7) encouraging the family and friends of such women to provide emotional
  support to the women; and
  `(8) referring such women for assistance with respect to establishing the
  eligibility of the women and their families for financial assistance and
  services under Federal, State, and local programs.
  `(e) PROVISIONS REGARDING SERVICES-
  `(1) PROVISION OF ALL SERVICES- The Secretary may not make a grant under
  subsection (a) unless the applicant for the grant agrees that each service
  under subsection (d) will be available through the applicant. With respect
  to compliance with such agreement, a grantee under such subsection may
  expend the grant to provide the services directly, and may expend the grant
  to enter into agreements with other public or nonprofit private entities
  under which the entities provide the services.
  `(2) USE OF NURSES- The Secretary may not make a grant under subsection (a)
  unless the applicant for the grant agrees that, to the extent practicable,
  services under subsection (d) will be provided through nurses.
  `(f) OUTREACH- In addition to the purpose described in subsection (a), a
  grant under such subsection may be expended to carry out outreach activities
  with lay people to inform women of the availability of services from the
  grantee of services under subsection (d).
  `(g) REQUIREMENT OF APPLICATION- The Secretary may not make a grant under
  subsection (a) unless an application for the grant is submitted to the
  Secretary and the application is in such form, is made in such manner,
  and contains such agreements, assurances, and information as the Secretary
  determines to be necessary to carry out this section.
  `(h) TECHNICAL ASSISTANCE- Upon the request of a grantee under subsection
  (a), the Secretary shall, directly or through contracts, provide training
  and technical assistance to the grantee with respect to the planning,
  development, evaluation, and operation of the program carried out pursuant
  to such subsection.
  `(i) EVALUATIONS-
  `(1) IN GENERAL- The Secretary shall, directly or through contracts with
  public or private entities, provide for evaluations of projects carried
  out pursuant to subsection (a). The evaluations shall include randomized
  trials and shall determine the extent to which the projects--
  `(A) have been successful in carrying out the purpose specified in such
  subsection;
  `(B) have been carried out in a cost-effective manner; and
  `(C) have, in the case of eligible women and young children served by the
  project, reduced the utilization by such individuals of services available
  to the individuals under the program established in title XIX of the Social
  Security Act and under other Federal, State, and local programs.
  `(2) ISSUANCE OF STANDARDS- The Secretary shall by regulation issue standards
  for carrying out evaluations under paragraph (1). The final rule for the
  regulations required by the preceding sentence shall be issued not later
  than 90 days after the date of the enactment of the Healthy Beginnings
  Act of 1991.
  `(3) REPORT TO CONGRESS- Not later than January 31 of 1993 and of each
  subsequent year, the Secretary shall submit to the Congress a report
  summarizing evaluations carried out under paragraph (1) during the preceding
  fiscal year.
  `(j) DEFINITIONS- For purposes of this section:
  `(1) COMMUNITY HEALTH CENTER- The term `community health center' has the
  meaning given such term in section 330.
  `(2) ELIGIBLE WOMEN- The term `eligible women' means women described in
  paragraph (1) or (3) of subsection (a).
  `(3) ELIGIBLE YOUNG CHILDREN- The term `eligible young children' means
  children described in subsection (a)(2).
  `(4) HOME- The term `home' means the home of the eligible woman involved.
  `(5) MEDICALLY UNDERSERVED POPULATION- The term `medically underserved
  population' has the meaning given such term in section 330(b)(3).
  `(6) MIGRANT HEALTH CENTER- The term `migrant health center' has the
  meaning given such term in section 329.
  `(7) PRIMARY HEALTH SERVICES- The term `primary health services' has the
  meaning given such term in section 330(b)(1).
  `(k) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out this
  section, there is authorized to be appropriated $100,000,000 for each of
  the fiscal years 1992 through 1994.'.
SEC. 4. EFFECTIVE DATE.
  This Act and the amendments made by this Act shall take effect October 1,
  1991, or upon the date of the enactment of this Act, whichever occurs later.
Healthy Beginnings Act of 1991

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