S. 1440: Prematurity Research Expansion and Education for Mothers who deliver Infants Early (PREEMIE) Reauthorization Act, as amended

S. 1440

Prematurity Research Expansion and Education for Mothers who deliver Infants Early (PREEMIE) Reauthorization Act, as amended

Sponsor
Sen. Lamar Alexander

Date
December 19, 2012 (112th Congress, 2nd Session)

Staff Contact
Communications

Floor Situation

On Wednesday, December 19, 2012, the House is scheduled to consider S. 1440, the PREEMIE Reauthorization Act, as amended under a suspension of the rules requiring a two-thirds majority vote for passage. The bill was introduced by Sen. Lamar Alexander (R-TN) on July 28, 2011, and referred to the Committee on Health, Education, Labor and Pensions. It passed the Senate with an amendment by voice on November 15, 2012. It was received in the House on November 16, 2012 and referred to the Committee on Energy and Commerce.

The bill includes text similar, but not identical, to H.R. 6163, the National Pediatric Research Network Act, which originally passed the House by voice on September 19, 2012.

The bill also includes text from H.R. 1852, the Children’s Hospital GME Support Reauthorization Act of 2011, which originally passed the House by voice on September 20, 2011.

The following Legislative Digest is based on the text of the bill as posted on the House Majority Leader’s website.

Bill Summary

S. 1440 would reauthorize programs intended to reduce preterm labor and delivery and the risk of pregnancy-related deaths and complications due to pregnancy; reduce infant mortality caused by prematurity; provide for a National Pediatric Research Network, including pediatric rare diseases or conditions; and reauthorize support for graduate medical education programs in children’s hospitals. 

Title I: Prematurity Research Expansion and Education for Mothers who Deliver Infants Early 

Sec. 101. Research and Activities at the Centers for Disease Control and Prevention: This section would authorize the Director of the Centers for Disease Control and Prevention (CDC) to conduct epidemiological studies on the clinical, biological, social, environmental, genetic, and behavioral factor relating to prematurity, conduct activities to improve data to facilitate tracking the burden of preterm birth, and continue efforts to prevent preterm birth through the identification of opportunities for prevention and the assessment of the impact of such efforts. The Director would be required to submit reports concerning the progress and results of these studies to Congress every two years.  Under the bill, these research activities would be reauthorized through 2017.

Sec. 102. Activities at the Health Resources and Services Administration: This section would require the Director of the Office for the Advancement of Telehealth to give preference to those who use the grant funds to develop telehealth networks that provide prenatal care for high-risk pregnancies. This section would also revise and reauthorize the authority of the Secretary to conduct demonstration projects that include programs to test and evaluate various strategies and to provide information and education to health care providers and the public on core risk factors, the importance of prenatal care, treatments, information needs of families, and evidence-based strategies.  These programs would be reauthorized through 2017.

Sec. 103. Other Activities:This section would repeal the establishment of the Interagency Coordinating Council on Prematurity and Low Birthweight and authorize the Secretary to establish the Advisory Committee on Infant Mortality. The bill would direct the Advisory Committee (or an existing advisory committee designated by the Secretary) to develop, and periodically review, a plan for conducting and supporting research, education, and programs on preterm birth through the Department of Health and Human Services (HHS). The section would also require the Secretary to designate an appropriate agency within HHS to coordinate existing studies and report to the Secretary and Congress on hospital readmissions of preterm infants.

Title II: National Pediatric Research Network

Sect. 201. National Pediatric Research Network: This section would authorize the Director of the National Institute for Health (NIH) to award funding to public or private nonprofit entities to establish, strengthen, or support pediatric research consortia. The bill would allow the Director of NIH to make awards to no more than eight pediatric research consortia, with a minimum of one pediatric research consortia that prioritizes collaboration with institutions serving rural areas. The Director of NIH may make awards for more than eight consortia based on need and must provide written notice to Congress of that intent.

This section would clarify that support for consortia is for a period of five years with additional extensions by the Director of NIH. This bill would require the Director of NIH to provide for the coordination of activities among the consortia and to require the periodic preparation and submission of reports on their activities. In addition, each consortium receiving an award shall provide assistance to the Centers for Disease Control and Prevention to establish and expand patient registries.

This section would also require the Director of NIH to ensure that an appropriate number of consortia agree to: (1) focus primarily on pediatric rare diseases or conditions; (2) conduct or coordinate multi-site clinical trials of therapies for, or approaches to, the prevention, diagnosis, or treatment of pediatric rare diseases or conditions; and (3) rapidly and efficiently disseminate scientific findings from such trials.

Title III: Children’s Hospital GME Support Reauthorization

Sec. 301. Program of Payments to Children’s Hospitals that operate GME Programs:This section would amend the Public Health Service Act to extend and reauthorize appropriations for payments associated with operating approved graduate medical residency training programs in children's hospitals for five years at current authorization levels ($330 million annually). The authorization under this bill would expire after FY2016.

Background

The PREEMIE Reauthorization Act will renew the 2006 PREEMIE Act signed into law in December, 2006. According to the bill’s sponsor, “this year in the U.S. alone, approximately 28,000 babies will die before their first birthday, 36 percent of those from pre-term birth complications. In addition to being the leading cause of newborn death, premature birth can cause a lifetime of health challenges and intellectual disabilities for those children who do survive. According to the Institute of Medicine (IOM), the annual societal costs associated with preterm birth were $26.2 billion in 2005 or $51,600 per infant born preterm. Nearly two-thirds of this $26.2 billion estimate was spent on medical care, and this number does not even include the cost of medical care beyond early childhood or caretaker costs such as lost wages. This legislation is supported by the March of Dimes Foundation, the American Academy of Pediatrics, the American Congress of Obstetricians and Gynecologists, the Association of Women’s Health, Obstetric and Neonatal Nurses, the Association of Maternal & Child Health Programs, and the Society for Maternal-Fetal Medicine.”

The bill would reauthorize the Children’s Hospital Graduate Medical Education (CHGME) program for an additional five years. The authorization amounts have not changed since H.R. 1852 was originally passed. According to H. Rept. 112-205, “the Children's Hospital Graduate Medical Education Program (CHGME) was enacted in 1999 as part of the Healthcare Research and Quality Act to provide freestanding children's hospitals with discretionary Federal support for direct and indirect expenses associated with operating medical residency training programs.” CBO describes direct expenses as “costs are those related to operating a medical education program, such as the salaries of medical students, while indirect costs are those intended to compensate hospitals for patient care costs that are expected to be higher in teaching hospitals than in non-teaching hospitals.” The Committee explains further, “since few children's hospitals receive Medicare funds, the legislation was designed to correct the exclusion of pediatric training in the Medicare GME program. CHGME provides funding to 56 hospitals in 30 states to support pediatric residency training. Today, freestanding children's hospitals train over 40% of pediatricians, 43% of pediatric specialists, and most pediatric researchers.”

The National Pediatric Research Network would advance research for a variety of pediatric disorders, including pediatric rare diseases or conditions. According to the original bill’s sponsor, while children represent 20 percent of the U.S. population, the NIH only spends 5 percent of its extramural funds on pediatric research. The National Pediatric Research Network Act is supported by the National Down Syndrome Congress, the National Down Syndrome Society, Parent Project Muscular Dystrophy, the National Organization of Rare Diseases (NORD), and the Children’s Hospital Association.

Cost

According to CBO, assuming appropriation of the necessary amounts, implementing S. 1440 would increase discretionary spending but CBO has not completed an estimate of the legislation’s impact on discretionary spending. Pay-as-you-go procedures do not apply to this legislation because it would not affect direct spending or revenues.

According to CBO’s 2011 estimate, H.R. 1852 would authorize the appropriation of $110 million a year for 2012 through 2016 for payment toward the direct costs of graduate medical education in children’s hospitals. The bill also would authorize the appropriation of $220 million a year for 2012 through 2016 for payment toward the indirect costs of graduate medical education programs. CBO estimates that implementing the bill would cost $248 million in 2012 and $1.57 billion over the 2012-2016 period, assuming the appropriations based on historic norms. Pay-as-you-go procedures do not apply to this legislation because it would not affect direct spending or revenues.

A CBO cost estimate on H.R. 6163, or all three bills combined, was not available at press time.