[House Report 111-48]
[From the U.S. Government Publishing Office]



111th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 1st Session                                                     111-48

======================================================================
 
                   MELANIE BLOCKER STOKES MOTHERS 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. 20]

      [Including cost estimate of the Congressional Budget Office]

  The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 20) to provide for research on, and services for 
individuals with, postpartum depression and psychosis, 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 ``Melanie Blocker Stokes Mom's 
Opportunity to Access Health, Education, Research, and Support for 
Postpartum Depression Act'' or the ``Melanie Blocker Stokes MOTHERS 
Act''.

SEC. 2. DEFINITIONS.

  For purposes of this Act--
          (1) the term ``postpartum condition'' means postpartum 
        depression or postpartum psychosis; and
          (2) the term ``Secretary'' means the Secretary of Health and 
        Human Services.

               TITLE I--RESEARCH ON POSTPARTUM CONDITIONS

SEC. 101. EXPANSION AND INTENSIFICATION OF ACTIVITIES.

  (a) Continuation of Activities.--The Secretary is encouraged to 
continue activities on postpartum conditions.
  (b) Programs for Postpartum Conditions.--In carrying out subsection 
(a), the Secretary is encouraged to continue research to expand the 
understanding of the causes of, and treatments for, postpartum 
conditions. Activities under such subsection shall include conducting 
and supporting the following:
          (1) Basic research concerning the etiology and causes of the 
        conditions.
          (2) Epidemiological studies to address the frequency and 
        natural history of the conditions and the differences among 
        racial and ethnic groups with respect to the conditions.
          (3) The development of improved screening and diagnostic 
        techniques.
          (4) Clinical research for the development and evaluation of 
        new treatments.
          (5) Information and education programs for health care 
        professionals and the public, which may include a coordinated 
        national campaign to increase the awareness and knowledge of 
        postpartum conditions. Activities under such a national 
        campaign may--
                  (A) include public service announcements through 
                television, radio, and other means; and
                  (B) focus on--
                          (i) raising awareness about screening;
                          (ii) educating new mothers and their families 
                        about postpartum conditions to promote earlier 
                        diagnosis and treatment; and
                          (iii) ensuring that such education includes 
                        complete information concerning postpartum 
                        conditions, including its symptoms, methods of 
                        coping with the illness, and treatment 
                        resources.

SEC. 102. SENSE OF CONGRESS REGARDING LONGITUDINAL STUDY OF RELATIVE 
                    MENTAL HEALTH CONSEQUENCES FOR WOMEN OF RESOLVING A 
                    PREGNANCY.

  (a) Sense of Congress.--It is the sense of Congress that the Director 
of the National Institute of Mental Health may conduct a nationally 
representative longitudinal study (during the period of fiscal years 
2009 through 2018) of the relative mental health consequences for women 
of resolving a pregnancy (intended and unintended) in various ways, 
including carrying the pregnancy to term and parenting the child, 
carrying the pregnancy to term and placing the child for adoption, 
miscarriage, and having an abortion. This study may assess the 
incidence, timing, magnitude, and duration of the immediate and long-
term mental health consequences (positive or negative) of these 
pregnancy outcomes.
  (b) Report.--Beginning not later than 3 years after the date of the 
enactment of this Act, and periodically thereafter for the duration of 
the study, such Director may prepare and submit to the Congress reports 
on the findings of the study.

     TITLE II--DELIVERY OF SERVICES REGARDING POSTPARTUM CONDITIONS

SEC. 201. ESTABLISHMENT OF GRANT PROGRAM.

  Subpart I of part D of title III of the Public Health Service Act (42 
U.S.C. 254b et seq.) is amended by inserting after section 330G the 
following:

``SEC. 330G-1. SERVICES TO INDIVIDUALS WITH A POSTPARTUM CONDITION AND 
                    THEIR FAMILIES.

  ``(a) In General.--The Secretary may make grants to eligible entities 
for projects for the establishment, operation, and coordination of 
effective and cost-efficient systems for the delivery of essential 
services to individuals with a postpartum condition and their families.
  ``(b) Certain Activities.--To the extent practicable and appropriate, 
the Secretary shall ensure that projects funded under subsection (a) 
provide education and services with respect to the diagnosis and 
management of postpartum conditions. The Secretary may allow such 
projects to include the following:
          ``(1) Delivering or enhancing outpatient and home-based 
        health and support services, including case management and 
        comprehensive treatment services for individuals with or at 
        risk for postpartum conditions, and delivering or enhancing 
        support services for their families.
          ``(2) Delivering or enhancing inpatient care management 
        services that ensure the well-being of the mother and family 
        and the future development of the infant.
          ``(3) Improving the quality, availability, and organization 
        of health care and support services (including transportation 
        services, attendant care, homemaker services, day or respite 
        care, and providing counseling on financial assistance and 
        insurance) for individuals with a postpartum condition and 
        support services for their families.
          ``(4) Providing education to new mothers and, as appropriate, 
        their families about postpartum conditions to promote earlier 
        diagnosis and treatment. Such education may include--
                  ``(A) providing complete information on postpartum 
                conditions, symptoms, methods of coping with the 
                illness, and treatment resources; and
                  ``(B) in the case of a grantee that is a State, 
                hospital, or birthing facility--
                          ``(i) providing education to new mothers and 
                        fathers, and other family members as 
                        appropriate, concerning postpartum conditions 
                        before new mothers leave the health facility; 
                        and
                          ``(ii) ensuring that training programs 
                        regarding such education are carried out at the 
                        health facility.
  ``(c) Integration With Other Programs.--To the extent practicable and 
appropriate, the Secretary may integrate the grant program under this 
section with other grant programs carried out by the Secretary, 
including the program under section 330.
  ``(d) Certain Requirements.--A grant may be made under this section 
only if the applicant involved makes the following agreements:
          ``(1) Not more than 5 percent of the grant will be used for 
        administration, accounting, reporting, and program oversight 
        functions.
          ``(2) The grant will be used to supplement and not supplant 
        funds from other sources related to the treatment of postpartum 
        conditions.
          ``(3) The applicant will abide by any limitations deemed 
        appropriate by the Secretary on any charges to individuals 
        receiving services pursuant to the grant. As deemed appropriate 
        by the Secretary, such limitations on charges may vary based on 
        the financial circumstances of the individual receiving 
        services.
          ``(4) The grant will not be expended to make payment for 
        services authorized under subsection (a) to the extent that 
        payment has been made, or can reasonably be expected to be 
        made, with respect to such services--
                  ``(A) under any State compensation program, under an 
                insurance policy, or under any Federal or State health 
                benefits program; or
                  ``(B) by an entity that provides health services on a 
                prepaid basis.
          ``(5) The applicant will, at each site at which the applicant 
        provides services funded under subsection (a), post a 
        conspicuous notice informing individuals who receive the 
        services of any Federal policies that apply to the applicant 
        with respect to the imposition of charges on such individuals.
          ``(6) For each grant period, the applicant will submit to the 
        Secretary a report that describes how grant funds were used 
        during such period.
  ``(e) Technical Assistance.--The Secretary may provide technical 
assistance to entities seeking a grant under this section in order to 
assist such entities in complying with the requirements of this 
section.
  ``(f) Definitions.--In this section:
          ``(1) The term `eligible entity' means a public or nonprofit 
        private entity, which may include a State or local government; 
        a public or nonprofit private recipient of a grant under 
        section 330H (relating to the Healthy Start Initiative), 
        public-private partnership, hospital, community-based 
        organization, hospice, ambulatory care facility, community 
        health center, migrant health center, public housing primary 
        care center, or homeless health center; or any other 
        appropriate public or nonprofit private entity.
          ``(2) The term `postpartum condition' means postpartum 
        depression or postpartum psychosis.''.

                     TITLE III--GENERAL PROVISIONS

SEC. 301. AUTHORIZATION OF APPROPRIATIONS.

  To carry out this Act and the amendment made by section 201, there 
are authorized to be appropriated, in addition to such other sums as 
may be available for such purpose--
          (1) $3,000,000 for fiscal year 2009; and
          (2) such sums as may be necessary for fiscal years 2010 and 
        2011.

SEC. 302. REPORT BY THE SECRETARY.

  (a) Study.--The Secretary shall conduct a study on the benefits of 
screening for postpartum conditions.
  (b) Report.--Not later than 2 years after the date of the enactment 
of this Act, the Secretary shall complete the study required by 
subsection (a) and submit a report to the Congress on the results of 
such study.

SEC. 303. LIMITATION.

  Notwithstanding any other provision of this Act or the amendment made 
by section 201, the Secretary may not utilize amounts made available 
under this Act or such amendment to carry out activities or programs 
that are duplicative of activities or programs that are already being 
carried out through the Department of Health and Human Services.

                                CONTENTS

                                                                   Page
Purpose and Summary..............................................     4
Background and Need for Legislation..............................     4
Hearings.........................................................     5
Committee Consideration..........................................     5
Committee Votes..................................................     5
Committee Oversight Findings.....................................     5
Statement of General Performance Goals and Objectives............     6
New Budget Authority, Entitlement Authority, and Tax Expenditures     6
Earmarks and Tax and Tariff Benefits.............................     6
Committee Cost Estimate..........................................     6
Congressional Budget Office Estimate.............................     6
Federal Mandates Statement.......................................     8
Advisory Committee Statement.....................................     8
Constitutional Authority Statement...............................     8
Applicability to Legislative Branch..............................     8
Section-by-Section Analysis of the Legislation...................     9
Explanation of Amendments........................................    10
Changes in Existing Law Made by the Bill, as Reported............    10

                          Purpose and Summary

    The purpose of H.R. 20, the ``Melanie Blocker Stokes Mom's 
Opportunity to Access Health, Education, Research, and Support 
for Postpartum Depression Act (the Melanie Blocker Stokes 
MOTHERS Act)'', is to provide research on and services for 
individuals with postpartum depression and psychosis. The 
legislation encourages the Secretary of Health and Human 
Services to continue activities and research on postpartum 
depression and post-partum psychosis and authorizes the 
appropriation of $3 million in FY2009 and such sums as may be 
necessary in FY2010 and FY2011 for the Secretary to make grants 
to support effective and cost-efficient systems for the 
delivery of essential services to individuals with such 
conditions.

                  Background and Need for Legislation

    Depression is a very common disorder, affecting 15% to 25% 
of the population and representing a yearly economic burden of 
$44 billion. Overall, depression is frequently undetected, with 
fewer than 25% of patients suffering from mental illness 
actually under the care of a mental health specialist. 
Depression is twice as common in women as it is in men, with 
its peak incidence during the primary reproductive years--ages 
25 to 45.
    Because women are more likely to experience depression 
during these years, they are especially vulnerable to 
developing depression during pregnancy and postpartum mental 
health disorders after childbirth. In the United States, there 
may be as many as 800,000 new cases of postpartum conditions 
each year. The spectrum of postpartum mood disorders is 
generally divided into three distinct categories, with the 
``maternity blues'' or ``baby blues'' at the mildest end of the 
spectrum.
    Postpartum depression occurs after 10% to 15% of all 
deliveries and after 26% to 32% of all adolescent deliveries. 
The majority of patients suffer from this illness for more than 
6 months and, if untreated, 25% of patients are still depressed 
a year later. Women with postpartum depression may feel 
restless, anxious, sad, or depressed. They may have feelings of 
guilt, decreased energy and motivation, and a sense of 
worthlessness. They may also have sleep difficulties and 
undergo unexplained weight loss or gain.
    The most severe postpartum condition is postpartum 
psychosis. A comparatively rare disease, it complicates only 
0.1% to 0.2% of deliveries. Symptoms generally present within 
the first 4 weeks of postpartum, when the risk of 
hospitalization is 22 times greater, but can manifest up to 90 
days after delivery. A second smaller peak in incidence is 
evident at 18 to 24 months. Patients suffering from postpartum 
psychosis are severely impaired, suffering from hallucinations 
and delusions that frequently focus on the infant dying or 
being divine or demonic. These hallucinations often command 
that the patient hurt herself or others, placing these mothers 
at the highest risk for committing infanticide and/or suicide.

                                Hearings

    The Committee on Energy and Commerce held a hearing on 
legislation similar to H.R. 20 on May 1, 2007, in the 110th 
Congress. The Subcommittee heard from two panels of witnesses 
and experts. The first panel consisted of testimony by 
Catherine Roca, M.D., Chief, Women's Programs, National 
Institute of Mental Health, National Institutes of Health. The 
second panel had five witnesses: Nada Stotland, M.D., M.P.H., 
Professor of Psychiatry and Obstetrics/Gynecology, Rush Medical 
College, Chicago (testifying on behalf of the American 
Psychiatric Association); Ms. Mary Jo Codey, Former First Lady 
of the State of New Jersey; Ms. Carol Blocker, mother of 
Melanie Blocker-Stokes; Priscilla K. Coleman, Ph.D., Associate 
Professor of Human Development and Family Studies, Bowling 
State University; and Ms. Michaelene Fredenburg, President, 
Life Perspectives. The Committee on Energy and Commerce did not 
hold hearings on the legislation in the 111th Congress.

                        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. 20 and several other bills en bloc. H.R. 20 was 
ordered favorably reported, amended, to the House by a voice 
vote. An amendment to H.R. 20 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. 20 reported to the House.

                      Committee Oversight Findings

    Pursuant to clause 3(c)(1) of rule XIII of the Rules of the 
House of Representatives, the Subcommittee on Health has held 
legislative hearings on legislation similar to H.R. 20 in the 
110th Congress and made oversight findings that are reflected 
in this report.

         Statement of General Performance Goals and Objectives

    H.R. 20 encourages the Secretary of Health and Human 
Services to continue activities on postpartum depression and 
postpartum psychosis. H.R. 20 encourages the Secretary to 
continue research to expand the understanding of the causes of, 
and treatments for, such conditions. H.R. 20 states that the 
Secretary may make grants to establish, operate, and coordinate 
effective and cost-efficient systems for the delivery of 
essential services to individuals with such conditions and 
their families. This legislation further allows the Secretary 
to provide technical assistance to grant recipients.

   New Budget Authority, Entitlement Authority, and Tax Expenditures

    In compliance with clause 3(c)(2) of rule XIII of the Rules 
of the House of Representatives, the Committee finds that H.R. 
20 would result in no new or increased budget authority, 
entitlement authority, or tax expenditures.

                  Earmarks and Tax and Tariff Benefits

    In compliance with clause 9 of rule XXI of the Rules of the 
House of Representatives, H.R. 20 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 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. 20 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 19, 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. 20, the Melanie 
Blocker Stokes MOTHERS Act.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Jamease 
Kowalczyk.
            Sincerely,
                                      Douglas W. Elmendorf,
                                                          Director.
    Enclosure.

H.R. 20--Melanie Blocker Stokes MOTHERS Act

    Summary: H.R. 20 would encourage the Secretary of Health 
and Human Services (HHS) to continue ongoing activities at the 
National Institutes of Health (NIH) and the Health Resources 
and Services Administration (HRSA) related to research and 
dissemination of information concerning postpartum depression 
or postpartum psychosis. The bill also would direct the 
Secretary to provide grants to public or nonprofit entities to 
establish and operate programs that provide health care and 
support services to individuals with postpartum depression or 
postpartum psychosis.
    For those purposes, the bill would authorize the 
appropriation of $3 million for fiscal year 2009 and such sums 
as are necessary for fiscal years 2010 and 2011. CBO estimates 
that implementing the bill would cost less than $500,000 in 
2009 and about $9 million over the 2009-2014 period, assuming 
the appropriation of the necessary amounts. Enacting H.R. 20 
would not affect direct spending or revenues.
    The bill contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act (UMRA); 
any costs to state and local governments would be incurred 
voluntarily.
    Estimated cost to the Federal Government: The estimated 
budgetary impact of H.R. 20 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    2014   2009-2014
----------------------------------------------------------------------------------------------------------------
                                  CHANGES IN SPENDING SUBJECT TO APPROPRIATION

Estimated Authorization Level........................       3       3       3       0       0       0         9
Estimated Outlays....................................       *       2       3       2       1       0        9
----------------------------------------------------------------------------------------------------------------
Note: = *Less than $500,000.

    Basis of estimate: For this estimate, CBO assumes that H.R. 
20 will be enacted before August 2009, that the authorized 
amounts will be appropriated for each year, and that outlays 
will follow historical spending patterns for similar programs.

Grants for services related to postpartum depression and psychosis

    H.R. 20 would authorize the Secretary of HHS to make grants 
to public or nonprofit entities for the establishment, 
operation, and coordination of systems for delivery of services 
to individuals with postpartum depression or postpartum 
psychosis. Not more than 5 percent of these grants could be 
used for administration, accounting, reporting, or program 
oversight. These grants would not be permitted to supplant 
funds from other sources, including federal and state health 
programs.
    H.R. 20 would authorize the appropriation of $3 million in 
fiscal year 2009 and such sums as are necessary in fiscal years 
2010 and 2011. CBO estimates that the $3 million authorized for 
appropriation in 2009 would fund a postpartum services grant 
program consistent with the requirements of the bill (none of 
the $3 million would be required for the research activities 
under the bill as described below). CBO estimates that an 
additional $3 million a year would be necessary to fund the 
grant program in 2010 and 2011. Implementing the grant program 
would cost less than $500,000 in 2009 and about $9 million over 
the 2009-2014 period.

Research on postpartum depression and psychosis

    H.R. 20 would encourage the Secretary of HHS, acting 
through the Director of the NIH, to continue research efforts 
related to postpartum depression and postpartum psychosis. Such 
research includes basic research, epidemiological research, the 
development of improved diagnostic techniques, clinical 
research, and information and education programs. According to 
officials at the NIH, the institutes currently support all of 
those activities.
    The bill also would encourage the Director of the NIH and 
the Administrator of HRSA carry out a national campaign to 
raise awareness of postpartum depression. According to 
officials at the NIH, the institutes already communicate and 
disseminate their research findings as required by law. Both 
the NIH and HRSA sponsor Web sites devoted to postpartum 
depression. According to officials at HHS, HRSA frequently uses 
public service announcements to communicate messages to the 
public. CBO estimates that there would be no cost to HRSA to 
implement those provisions, because they would not involve any 
change in the agency's activities.
    Intergovernmental and private-sector impact: H.R. 20 
contains no intergovernmental mandates as defined in UMRA. 
Grants authorized in the bill would benefit state and local 
governments that provide services for diagnosing and managing 
postpartum depression. Any costs to those governments to comply 
with grant conditions would be incurred voluntarily.
    Estimate prepared by: Federal Costs: Jamease Kowalczyk; 
Impact on State, Local, and Tribal Governments: Lisa Ramirez-
Branum; Impact on Private Sector: Keisuke Nakagawa.
    Estimate approved by: Peter H. Fontaine, Assistant Director 
for Budget Analysis.

                       Federal Mandates Statement

    The Committee adopts as its own the estimate of federal 
mandates 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. 20.

                   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 this legislation 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 the legislation 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.

             Section-by-Section Analysis of the Legislation


Section 1. Short title

    Section 1 establishes the short title of the Act as the 
``Melanie Blocker Stokes MOTHERS Act''.

Section 2. Definitions

    Section 2 defines postpartum conditions as postpartum 
depression or postpartum psychosis. It also defines 
``Secretary'' as the Secretary of Health and Human Services.

        TITLE I--RESEARCH ON POSTPARTUM DEPRESSION AND PSYCHOSIS

    Title I addresses the activities and research related to 
postpartum depression and psychosis.
    Section 101 encourages the Secretary to continue activities 
on postpartum conditions and to continue research to expand the 
understanding of the causes of, and treatments for, these 
conditions. These activities include: basic research on the 
causes of these conditions; epidemiological studies on the 
frequency and history of the conditions as well as differences 
among racial and ethnic groups with respect to these 
conditions; development of improved screening and diagnostic 
techniques; research on new treatments; and information and 
education programs for health care professionals and the 
public. Information and education programs may include a 
coordinated national campaign to increase the awareness and 
knowledge of postpartum conditions.
    Section 102 is the sense of Congress that the Director of 
the National Institute of Mental Health may conduct a 
nationally representative longitudinal study (during the period 
of fiscal years 2009 through 2018) of the relative mental 
health consequences for women of resolving a pregnancy 
(intended and unintended) in various ways, including carrying 
the pregnancy to term and parenting the child, carrying the 
pregnancy to term and placing the child for adoption, 
miscarriage, and having an abortion. This study may assess the 
incidence, timing, magnitude, and duration of the immediate and 
long-term mental health consequences (positive or negative) of 
these pregnancy outcomes.

  TITLE II--DELIVERY OF SERVICES REGARDING POSTPARTUM DEPRESSION AND 
                               PSYCHOSIS

    Title II addresses the establishment of grant programs 
related to postpartum depression and psychosis.
    Section 201 amends Subpart I of part D of title III of the 
Public Health Service Act (42 U.S.C. 254b et seq.) to create 
section 330G.
    Section 330G-1. Services to individuals with a postpartum 
condition and their families. Section 330G-1 gives the 
Secretary discretionary authority to make grants to provide for 
projects for the establishment, operation, and coordination of 
effective and cost-efficient systems for the delivery of 
essential services to individuals with postpartum depression or 
postpartum psychosis. Recipients of these grants must be either 
a public or nonprofit private entity, which may include a state 
or local government; a public or nonprofit private recipient of 
a grant under section 330H (relating to the Healthy Start 
Initiative), public-private partnership, hospital, community-
based organization, hospice, ambulatory care facility, 
community health center, migrant health center, public housing 
primary care center, or homeless health center; or any other 
appropriate public or nonprofit private entity. To the extent 
practicable and appropriate, the Secretary may integrate the 
grant program under this section with other grant programs 
carried out by the Secretary. The Secretary may also provide 
technical assistance to entities seeking a grant under this 
section in order to assist them in complying with the 
requirements of this section.

                     TITLE III--GENERAL PROVISIONS

    Section 301 authorizes $3,000,000 to be appropriated for 
fiscal year 2009, and such sums as may be necessary for fiscal 
years 2010 and 2011.
    Section 302 directs the Secretary to conduct a study on the 
benefits for screening for postpartum conditions. The Secretary 
is directed to submit the report to Congress no later than two 
years after the enactment of this Act.
    Section 303 prohibits the Secretary from using any funds 
authorized by this legislation to carry out activities or 
programs that are duplicative of activities or programs that 
are already being carried out through the Department of Health 
and Human Services.

                       Explanation of Amendments

    Mr. Waxman offered an amendment that changed the date by 
which the Secretary would report findings on the report in 
Section 102 from five to three years; and clarified the 
categories of entities eligible for grants under Section 201.

         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 (new matter is 
printed in italic and 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 D--Primary Health Care


Subpart I--Health Centers

           *       *       *       *       *       *       *



SEC. 330G-1. SERVICES TO INDIVIDUALS WITH A POSTPARTUM CONDITION AND 
                    THEIR FAMILIES.

  (a) In General.--The Secretary may make grants to eligible 
entities for projects for the establishment, operation, and 
coordination of effective and cost-efficient systems for the 
delivery of essential services to individuals with a postpartum 
condition and their families.
  (b) Certain Activities.--To the extent practicable and 
appropriate, the Secretary shall ensure that projects funded 
under subsection (a) provide education and services with 
respect to the diagnosis and management of postpartum 
conditions. The Secretary may allow such projects to include 
the following:
          (1) Delivering or enhancing outpatient and home-based 
        health and support services, including case management 
        and comprehensive treatment services for individuals 
        with or at risk for postpartum conditions, and 
        delivering or enhancing support services for their 
        families.
          (2) Delivering or enhancing inpatient care management 
        services that ensure the well-being of the mother and 
        family and the future development of the infant.
          (3) Improving the quality, availability, and 
        organization of health care and support services 
        (including transportation services, attendant care, 
        homemaker services, day or respite care, and providing 
        counseling on financial assistance and insurance) for 
        individuals with a postpartum condition and support 
        services for their families.
          (4) Providing education to new mothers and, as 
        appropriate, their families about postpartum conditions 
        to promote earlier diagnosis and treatment. Such 
        education may include--
                  (A) providing complete information on 
                postpartum conditions, symptoms, methods of 
                coping with the illness, and treatment 
                resources; and
                  (B) in the case of a grantee that is a State, 
                hospital, or birthing facility--
                          (i) providing education to new 
                        mothers and fathers, and other family 
                        members as appropriate, concerning 
                        postpartum conditions before new 
                        mothers leave the health facility; and
                          (ii) ensuring that training programs 
                        regarding such education are carried 
                        out at the health facility.
  (c) Integration With Other Programs.--To the extent 
practicable and appropriate, the Secretary may integrate the 
grant program under this section with other grant programs 
carried out by the Secretary, including the program under 
section 330.
  (d) Certain Requirements.--A grant may be made under this 
section only if the applicant involved makes the following 
agreements:
          (1) Not more than 5 percent of the grant will be used 
        for administration, accounting, reporting, and program 
        oversight functions.
          (2) The grant will be used to supplement and not 
        supplant funds from other sources related to the 
        treatment of postpartum conditions.
          (3) The applicant will abide by any limitations 
        deemed appropriate by the Secretary on any charges to 
        individuals receiving services pursuant to the grant. 
        As deemed appropriate by the Secretary, such 
        limitations on charges may vary based on the financial 
        circumstances of the individual receiving services.
          (4) The grant will not be expended to make payment 
        for services authorized under subsection (a) to the 
        extent that payment has been made, or can reasonably be 
        expected to be made, with respect to such services--
                  (A) under any State compensation program, 
                under an insurance policy, or under any Federal 
                or State health benefits program; or
                  (B) by an entity that provides health 
                services on a prepaid basis.
          (5) The applicant will, at each site at which the 
        applicant provides services funded under subsection 
        (a), post a conspicuous notice informing individuals 
        who receive the services of any Federal policies that 
        apply to the applicant with respect to the imposition 
        of charges on such individuals.
          (6) For each grant period, the applicant will submit 
        to the Secretary a report that describes how grant 
        funds were used during such period.
  (e) Technical Assistance.--The Secretary may provide 
technical assistance to entities seeking a grant under this 
section in order to assist such entities in complying with the 
requirements of this section.
  (f) Definitions.--In this section:
          (1) The term ``eligible entity'' means a public or 
        nonprofit private entity, which may include a State or 
        local government; a public or nonprofit private 
        recipient of a grant under section 330H (relating to 
        the Healthy Start Initiative), public-private 
        partnership, hospital, community-based organization, 
        hospice, ambulatory care facility, community health 
        center, migrant health center, public housing primary 
        care center, or homeless health center; or any other 
        appropriate public or nonprofit private entity.
          (2) The term ``postpartum condition'' means 
        postpartum depression or postpartum psychosis.

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