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110th Congress Report
HOUSE OF REPRESENTATIVES
1st Session 110-376
VISION CARE FOR KIDS ACT OF 2007
October 15, 2007.--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
R E P O R T
[To accompany H.R. 507]
[Including cost estimate of the Congressional Budget Office]
The Committee on Energy and Commerce, to whom was referred
the bill (H.R. 507) to establish a grant program to provide
vision care to children, and for other purposes, having
considered the same, report favorably thereon with an amendment
and recommend that the bill as amended do pass.
Purpose and Summary.............................................. 3
Background and Need for Legislation.............................. 3
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 5
Earmarks and Tax and Tariff Benefits............................. 5
Committee Cost Estimate.......................................... 5
Congressional Budget Office Estimate............................. 5
Federal Mandates Statement....................................... 7
Advisory Committee Statement..................................... 7
Constitutional Authority Statement............................... 7
Applicability to Legislative Branch.............................. 7
Section-by-Section Analysis of the Legislation................... 7
The amendment is as follows:
Strike all after the enacting clause and insert the
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Vision Care for Kids Act of 2007''.
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) Millions of children in the United States suffer from
vision problems, many of which go undetected. Because children
with vision problems can struggle developmentally, resulting in
physical, emotional, and social consequences, good vision is
essential for proper physical development and educational
(2) Vision problems in children range from common conditions
such as refractive errors, amblyopia, strabismus, ocular
trauma, and infections, to rare but potentially life- or sight-
threatening problems such as retinoblastoma, infantile
cataracts, congenital glaucoma, and genetic or metabolic
diseases of the eye.
(3) Since many serious ocular conditions are treatable if
identified in the preschool and early school-age years, early
detection provides the best opportunity for effective treatment
and can have far-reaching implications for vision.
(4) Various identification methods, including vision
screening and comprehensive eye examinations required by State
laws, can be helpful in identifying children needing services.
A child identified as needing services through vision screening
should receive a comprehensive eye examination followed by
subsequent treatment as needed. Any child identified as needing
services should have access to subsequent treatment as needed.
(5) There is a need to increase public awareness about the
prevalence and devastating consequences of vision disorders in
children and to educate the public and health care providers
about the warning signs and symptoms of ocular and vision
disorders and the benefits of early detection, evaluation, and
SEC. 3. GRANTS REGARDING VISION CARE FOR CHILDREN.
(a) In General.--The Secretary of Health and Human Services (referred
to in this section as the ``Secretary''), acting through the Director
of the Centers for Disease Control and Prevention, may award grants to
States on the basis of an established review process for the purpose of
complementing existing State efforts for--
(1) providing comprehensive eye examinations by a licensed
optometrist or ophthalmologist for children who have been
previously identified through a vision screening or eye
examination by a licensed health care provider or vision
screener as needing such services, with priority given to
children who are under the age of 9 years;
(2) providing treatment or services, subsequent to the
examinations described in paragraph (1), necessary to correct
vision problems; and
(3) developing and disseminating, to parents, teachers, and
health care practitioners, educational materials on recognizing
signs of visual impairment in children.
(b) Criteria and Coordination.--
(1) Criteria.--The Secretary, in consultation with
appropriate professional and patient organizations including
individuals with knowledge of age appropriate vision services,
shall develop criteria--
(A) governing the operation of the grant program
under subsection (a); and
(B) for the collection of data related to vision
assessment and the utilization of follow-up services.
(2) Coordination.--The Secretary shall, as appropriate,
coordinate the program under subsection (a) with the program
under section 330 of the Public Health Service Act (relating to
health centers) (42 U.S.C. 254b), the program under title XIX
of the Social Security Act (relating to the Medicaid program)
(42 U.S.C. 1396 et seq.), the program under title XXI of such
Act (relating to the State children's health insurance program)
(42 U.S.C. 1397aa et seq.), and with other Federal or State
programs that provide services to children.
(c) Application.--To be eligible to receive a grant under subsection
(a), a State shall submit to the Secretary an application in such form,
made in such manner, and containing such information as the Secretary
may require, including--
(1) information on existing Federal, Federal-State, or State-
funded children's vision programs;
(2) a plan for the use of grant funds, including how funds
will be used to complement existing State efforts (including
possible partnerships with non-profit entities);
(3) a plan to determine if a grant eligible child has been
identified as provided for in subsection (a); and
(4) a description of how funds will be used to provide items
or services, only as a secondary payer--
(A) for an eligible child, to the extent that the
child is not covered for the items or services under
any State compensation program, under an insurance
policy, or under any Federal or State health benefits
(B) for an eligible child, to the extent that the
child receives the items or services from an entity
that provides health services on a prepaid basis.
(d) Evaluations.--To be eligible to receive a grant under subsection
(a), a State shall agree that, not later than 1 year after the date on
which amounts under the grant are first received by the State, and
annually thereafter while receiving amounts under the grant, the State
will submit to the Secretary an evaluation of the operations and
activities carried out under the grant, including--
(1) an assessment of the utilization of vision services and
the status of children receiving these services as a result of
the activities carried out under the grant;
(2) the collection, analysis, and reporting of children's
vision data according to guidelines prescribed by the
(3) such other information as the Secretary may require.
(e) Limitations in Expenditure of Grant.--A grant may be made under
subsection (a) only if the State involved agrees that the State will
not expend more than 20 percent of the amount received under the grant
to carry out the purpose described in paragraph (3) of such subsection.
(f) Matching Funds.--
(1) In general.--With respect to the costs of the activities
to be carried out with a grant under subsection (a), a
condition for the receipt of the grant is that the State
involved agrees to make available (directly or through
donations from public or private entities) non-Federal
contributions toward such costs in an amount that is not less
than 25 percent of such costs.
(2) Determination of amount contributed.--Non-Federal
contributions required in paragraph (1) may be in cash or in
kind, fairly evaluated, including plant, equipment, or
services. Amounts provided by the Federal Government, or
services assisted or subsidized to any significant extent by
the Federal Government, may not be included in determining the
amount of such non-Federal contributions.
(g) Definition.--For purposes of this section, the term
``comprehensive eye examination'' includes an assessment of a patient's
history, general medical observation, external and ophthalmoscopic
examination, visual acuity, ocular alignment and motility, refraction,
and as appropriate, binocular vision or gross visual fields, performed
by an optometrist or an ophthalmologist.
(h) Authorization of Appropriations.--For the purpose of carrying out
this section, there is authorized to be appropriated $65,000,000 for
the period of fiscal years 2009 through 2013.
PURPOSE AND SUMMARY
The purpose of H.R. 507, the Vision Care for Kids Act of
2007, is to establish a grant program to provide care for
children with visual impairment.
BACKGROUND AND NEED FOR LEGISLATION
Vision impairment affects approximately 1.2 out of every
1,000 children who are 8 years of age. Vision problems can
occur at any point during a lifetime, but tend to be
particularly damaging to school age children because
developmental struggles may result in physical, emotional, and
social consequences. For instance, a child may miss learning
opportunities by failing to explore his or her environment.
Additionally, if a child is visually impaired, he or she may be
unable to imitate social behavior or understand nonverbal cues.
A component of Healthy People, Healthy Vision 2010
underscores the need for correcting children's vision problems
at a young age. Healthy Vision 2010 recommends that all
children receive a vision-screening exam from their healthcare
provider before they reach the age of 5. Early recognition of
eye disease results in more effective treatment that can be
sight-saving or even life-saving. Yet, in 2002, 36 percent of
children under the age of 5 did not receive any vision
In addition to the psychological costs, the economic costs
for people with impaired vision are very high. It is estimated
that the lifetime costs for all people with vision impairment
who were born in 2000 will total $2.5 billion. These costs
include both direct and indirect costs. Direct medical costs
include doctor visits, prescription drugs, and inpatient
hospital stays; direct non-medical expenses can include home
modifications and special education. Indirect costs account for
the majority of costs, and include the value of lost wages when
a person dies early, cannot work, or is limited in the amount
or type of work he or she can perform.
The Committee on Energy and Commerce has not held hearings
on the legislation.
On Thursday, July 19, 2007, the Subcommittee on Health met
in open markup session and favorably forwarded H.R. 507 to the
full Committee, amended, by a voice vote. On Thursday,
September 27, 2007, the full Committee met in open markup
session and ordered H.R. 507 favorably reported to the House,
as amended by the Subcommittee, by a voice vote. No amendments
were offered during full Committee consideration.
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 of H.R.
507 or in connection with ordering the bill reported. A motion
by Mr. Dingell to order H.R. 507 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 are reflected in this report.
STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES
H.R. 507 would allow the Secretary of Health and Human
Services, acting through the Director of the Centers for
Disease Control and Prevention (CDC), to award grants to States
to: (1) provide comprehensive eye examinations by a licensed
optometrist or ophthalmologist for children identified by a
licensed healthcare provider or vision screener, with priority
to children under age 9; (2) provide treatment or services to
correct vision problems of such children; and (3) develop and
disseminate educational materials on recognizing signs of
visual impairment in children.
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.
507 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. 507 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
provided by the Congressional Budget Office pursuant to section
402 of the Congressional Budget Act of 1974:
Congressional Budget Office,
Washington, DC, October 10, 2007.
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. 507, the Vision
Care for Kids Act of 2007.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contacts are Tim
Gronniger and Jeanne De Sa.
Robert A. Sunshine
(for Peter R. Orszag, Director).
H.R. 507--Vision Care for Kids Act of 2007
Summary: H.R. 507 would direct the Centers for Disease
Control and Prevention (CDC) to administer grants to states to
increase examinations of children for vision problems, arrange
for treatment of any problems detected, and conduct education
to promote detection of vision disorders. For those purposes it
would authorize the appropriation of $65 million over the 2009-
2013 period. Based on historical patterns of spending for
similar activities, CBO estimates that implementing H.R. 507
would cost $38 million over the 2009-2012 period and $65
million over the 2009-2017 period, assuming appropriation of
the authorized amount. In addition to those discretionary
costs, CBO estimates that the additional eye examinations
resulting from H.R. 507 would lead to some additional spending
for Medicaid, which pays for vision services for eligible
children. Any such increase in Medicaid spending would depend
upon future appropriations for the CDC grant program.
The bill contains no intergovernmental or private-sector
mandates, as defined in the Unfunded Mandates Reform Act
(UMRA). Any costs to states would be incurred voluntarily.
The estimated budgetary impact of H.R. 507 is shown in the
following table. The costs of this legislation fall within
budget function 550 (health).
By fiscal year, in millions of
2008 2009 2010 2011 2012
CHANGES IN SPENDING SUBJECT TO APPROPRIATION
Estimated Authorization Level 0 10 13 14 14
Estimated Outlays 0 4 9 12 13
Basis of estimate: H.R. 507 would authorize the
appropriation of $65 million to the CDC for the 2009-2013
period for purposes of detecting and treating vision disorders
in children. In particular, the CDC would be directed to
administer grants to States for three purposes: (1) providing
eye examinations of children with potential eye disorders, as
identified by screenings; (2) funding treatment of disorders
diagnosed during those examinations; and (3) educating parents,
teachers, and health care practitioners on symptoms of eye
disorders to improve detection of such diseases. States would
be required to seek reimbursement from private and other public
payors (such as Medicaid and the State Children's Health
Insurance Program) before applying grant funds towards
treatment of vision disorders.
Based on historical spending patterns for similar programs
at CDC, and assuming appropriation of the authorized amount,
CBO estimates that implementing H.R. 507 would cost $38 million
over the 2009-2012 period and $65 million over the 2009-2017
period. (There would be no budgetary effect in 2008 because the
bill would not authorize appropriations until 2009.)
In addition to the above discretionary costs (arising from
appropriations), CBO estimates that H.R. 507 would generate
some additional direct spending in the Medicaid program
(assuming appropriation of the amount authorized for the CDC
grant program). That spending would arise under title XIX of
the Social Security Act, which guarantees coverage for certain
forms of vision benefits for certain children eligible for
Medicaid. The vision examinations authorized by H.R. 507 would
identify some children with vision disorders who would not
otherwise be treated, and a portion of those costs would be
paid by the Medicaid program. Such costs, which could be
significant, would not be directly attributable to this bill
because they would only be triggered by a future appropriation.
(Spending by the State Children's Health Insurance Program
would be unaffected because its total budget authority is
capped under current law.)
Intergovernmental and private-sector impact: H.R. 507
contains no intergovernmental or private-sector mandates as
defined in UMRA. States that provide services to children for
screening and treating vision problems would benefit from grant
funds authorized in the bill. Any costs they incur to comply
with grant conditions, including matching funds, would be
Estimate prepared by: Federal Costs: Tim Gronniger and
Jeanne De Sa; Impact on State, Local, and Tribal Governments:
Lisa Ramirez-Branum; Impact on the Private Sector: Keisuke
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
ADVISORY COMMITTEE STATEMENT
No advisory committees within the meaning of section 5(b)
of the Federal Advisory Committee Act were created by this
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
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
``Vision Care for Kids Act of 2007.''
Section 2. Findings.
Section 2 sets out the finding of the Act.
Section 3. Grants regarding vision care for children.
Section 3 amends the Public Health Service Act to allow the
Secretary of Health and Human Services, acting through the
Director for the Centers for Disease Control and Prevention, to
award grants to States to: (1) provide comprehensive eye
examinations by a licensed optometrist or ophthalmologist for
children identified by a licensed healthcare provider or vision
screener, with priority to children under age 9; (2) provide
treatment or services to correct vision problems of such
children; and (3) develop and disseminate educational materials
on recognizing signs of visual impairment in children.