Jackie Walorski Maternal and Child Home Visiting Reauthorization Act of 2022 — House Report 117-559, Part 1
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This is House Report 117-559, Part 1, of the 117th Congress, 2d Session, titled Jackie Walorski Maternal and Child Home Visiting Reauthorization Act of 2022, from the Committee on Ways and Means, ordered to be printed November 15, 2022. Mr. Neal reports on H.R. 8876, to reauthorize the Maternal, Infant, and Early Childhood Home Visiting program, which the Committee reports favorably with an amendment and recommends that the bill as amended do pass. The report includes a cost estimate of the Congressional Budget Office. The amendment text provides for an outcomes dashboard under section 511(d)(1) of the Social Security Act and for funding under section 511(c)(4).
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“Jackie Walorski Maternal and Child Home Visiting Reauthorization Act of 2022 — House Report 117-559, Part 1.”
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117TH CONGRESS REPT. 117–559
" HOUSE OF REPRESENTATIVES !
2d Session Part 1
JACKIE WALORSKI MATERNAL AND CHILD HOME
VISITING REAUTHORIZATION ACT OF 2022
NOVEMBER 15, 2022.—Ordered to be printed
Mr. NEAL, from the Committee on Ways and Means,
submitted the following
R E P O R T
[To accompany H.R. 8876]
[Including cost estimate of the Congressional Budget Office]
The Committee on Ways and Means, to whom was referred the
bill (H.R. 8876) to reauthorize the Maternal, Infant, and Early
Childhood Home Visiting program, and for other purposes, having
considered the same, reports favorably thereon with an amendment
and recommends that the bill as amended do pass.
CONTENTS
Page
I. SUMMARY AND BACKGROUND ............................................................... 9
A. Purpose and Summary ..................................................................... 9
B. Background and Need for Legislation ............................................. 9
C. Legislative History ............................................................................ 12
II. EXPLANATION OF THE BILL ................................................................... 13
A. The Jackie Walorski Maternal and Child Home Visiting Reau-
thorization Act of 2022 ................................................................... 13
III. VOTES OF THE COMMITTEE .................................................................... 25
IV. BUDGET EFFECTS OF THE BILL ............................................................ 25
A. Committee Estimate of Budgetary Effects ...................................... 25
B. Statement Regarding New Budget Authority and Tax Expendi-
tures Budget Authority .................................................................. 25
C. Cost Estimate Prepared by the Congressional Budget Office ....... 26
V. OTHER MATTERS TO BE DISCUSSED UNDER THE RULES OF
THE HOUSE .............................................................................................. 27
A. Committee Oversight Findings and Recommendations ................. 27
B. Statement of General Performance Goals and Objectives ............. 27
C. Information Relating to Unfunded Mandates ................................ 28
D. Advisory Committee Statement ....................................................... 28
E. Applicability to Legislative Branch ................................................. 28
F. Congressional Earmarks, Limited Tax Benefits, and Limited
Tariff Benefits ................................................................................. 28
G. Duplication of Federal Programs ..................................................... 28
39–006
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H. Hearings ............................................................................................ 28
VI. CHANGES IN EXISTING LAW MADE BY THE BILL ............................. 28
A. Text of Existing Law Amended or Repealed by The Bill ............... 28
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 ‘‘Jackie Walorski Maternal and Child Home Visiting
Reauthorization Act of 2022’’.
SEC. 2. OUTCOMES DASHBOARD.
Section 511(d)(1) of the Social Security Act (42 U.S.C. 711(d)(1)) is amended—
(1) in the paragraph heading, by striking ‘‘BENCHMARK AREAS’’ and inserting
‘‘BENCHMARK AREAS RELATED TO INDIVIDUAL FAMILY OUTCOMES’’;
(2) in subparagraph (D)(i), by striking ‘‘(B)’’ and inserting ‘‘(C)’’; and
(3) by redesignating subparagraphs (B) through (D) as subparagraphs (C)
through (E), respectively, and inserting after subparagraph (A) the following:
‘‘(B) OUTCOMES DASHBOARDS.—The Secretary shall, directly or by grant or
contract, establish and operate a website accessible to the public that in-
cludes an annually updated dashboard that—
‘‘(i) provides easy-to-understand information on the outcomes
achieved by each eligible entity with respect to each of the benchmarks
described in subparagraph (A) of this paragraph that apply to the eligi-
ble entity, which shall be based on only the data elements or types of
data collected before the date of the enactment of this section unless
administering agencies and the Secretary agree pursuant to subsection
(h)(6) that additional data is required;
‘‘(ii) includes a template provided by the Secretary that will enable
comparison among eligible entities not referred to in subsection
(k)(2)(A) of—
‘‘(I) a profile of each eligible entity showing outcome indicators
and how the outcomes compare to benchmarks described in sub-
clause (II);
‘‘(II) information on the outcome indicators and requisite outcome
levels established for each eligible entity;
‘‘(III) information on each model employed in the program oper-
ated by each eligible entity, and regarding each benchmark area
described in subsection (d)(1)(A) in which the model used by the el-
igible entity is expected to affect participant outcomes;
‘‘(IV) the most recently available information from the report re-
quired by subparagraph (E) of this paragraph;
‘‘(V) an electronic link to the State needs assessment under sub-
section (b)(1); and
‘‘(VI) information regarding any penalty imposed, or other correc-
tive action taken, by the Secretary against a State for failing to
achieve a requisite outcome level or any other requirement imposed
by or under this section, and an indication as to whether the eligi-
ble entity is operating under a corrective action plan under sub-
paragraph (E)(ii) of this paragraph, and if so, a link to the plan,
an explanation of the reason for the implementation of the plan,
and a report on any progress made in operating under the plan;
‘‘(iii) includes information relating to those eligible entities for which
funding is reserved under subsection (k)(2)(A), with modifications as
necessary to reflect tribal sovereignty, data privacy, and participant
confidentiality; and
‘‘(iv) protects data privacy and confidentiality of participant fami-
lies.’’.
SEC. 3. FUNDING.
(a) GRANT AMOUNTS.—
(1) IN GENERAL.—Section 511(c)(4) of the Social Security Act (42 U.S.C.
711(c)(4)) is amended to read as follows:
‘‘(4) GRANT AMOUNTS.—
‘‘(A) BASE GRANTS.—
‘‘(i) IN GENERAL.—
‘‘(I) GENERAL RULE.—With respect to each of fiscal years 2023
through 2027 for which an eligible entity not referred to in sub-
section (k)(2)(A) is awarded a base grant under this section, the
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amount of the grant payable to the eligible entity for the fiscal year
is the amount described by clause (ii) of this subparagraph with re-
spect to the eligible entity, except as provided in subclause (II) of
this clause.
‘‘(II) SUBSTITUTION OF SUCCESSOR ELIGIBLE ENTITY FOR PREDE-
CESSOR.—If the 1st fiscal year for which an eligible entity is award-
ed a base grant under this section for a program operated in a
State is among fiscal years 2024 through 2027, the amount de-
scribed by clause (ii) with respect to the eligible entity is the
amount of the base grant for which a program operated in the
State was eligible under this subparagraph for fiscal year 2023.
‘‘(ii) AMOUNT DESCRIBED.—
‘‘(I) GENERAL RULE.—Subject to the succeeding provisions of this
clause, the amount described by this clause with respect to an eligi-
ble entity is—
‘‘(aa) the amount made available under subsection (k) for
base grants for fiscal year 2023 that remains after making the
reservations required by subsection (k)(2) or any other reduc-
tions required by Federal law for fiscal year 2023; multiplied
by
‘‘(bb) the percentage of children in all States who have not
attained 5 years of age (as determined by the Secretary on the
basis of the data most recently available before fiscal year
2023) that is represented by the number of such children in
the State in which the eligible entity is operating a program
pursuant to this section (as so determined).
‘‘(II) ADJUSTMENTS TO ENSURE STABLE FUNDING.—If the amount
otherwise payable to an eligible entity under subclause (I) for fiscal
year 2023 is less than 90 percent, or greater than 110 percent, of
the amount payable under this section to the eligible entity for the
program for fiscal year 2021, the Secretary shall increase the
amount otherwise so payable to 90 percent, or decrease the amount
otherwise so payable to 110 percent, as the case may be, of the
amount otherwise so payable.
‘‘(III) ADJUSTMENT TO ENSURE ALL BASE GRANT FUNDS ARE ALLO-
CATED.—If the amount described by subclause (I)(aa) is different
than the total of the amounts otherwise described by subclause (I)
after applying subclause (II), the Secretary shall increase or de-
crease the amounts otherwise so described after applying subclause
(II) by such equal percentage as is necessary to reduce that dif-
ference to zero.
‘‘(IV) MINIMUM BASE GRANT AMOUNT.—Notwithstanding the pre-
ceding provisions of this clause, the amount described by this
clause with respect to an eligible entity shall be not less than
$1,000,000.
‘‘(B) MATCHING GRANTS.—
‘‘(i) AMOUNT OF GRANT.—
‘‘(I) GENERAL RULE.—With respect to each of fiscal years 2024
through 2027 for which an eligible entity not referred to in sub-
section (k)(2)(A) is awarded a grant under this section, the Sec-
retary shall increase the amount of the grant payable to the eligi-
ble entity for the fiscal year under subparagraph (A) of this para-
graph by the matching amount (if any) determined under sub-
clause (II) of this clause with respect to the eligible entity for the
fiscal year and the additional matching amount (if any) determined
under clause (iii) of this subparagraph with respect to the eligible
entity for the fiscal year.
‘‘(II) MATCHING AMOUNT.—
‘‘(aa) IN GENERAL.—Subject to item (bb) of this subclause, the
matching amount with respect to an eligible entity for a fiscal
year is 75 percent of the sum of—
‘‘(AA) the total amount obligated by the eligible entity
for home visiting services in the State for the fiscal year,
from Federal funds made available for the fiscal year
under this subparagraph; and
‘‘(BB) the total amount so obligated by the eligible entity
from non-Federal funds, determined under subclause (III).
‘‘(bb) LIMITATION.—The matching amount with respect to an
eligible entity for a fiscal year shall not exceed the allotment
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under subclause (IV) for the State in which the eligible entity
is operating a program under this section for the fiscal year.
‘‘(III) DETERMINATION OF OBLIGATIONS FROM NON-FEDERAL
FUNDS.—For purposes of this clause, the total amount obligated by
an eligible entity from non-Federal funds is the total of the
amounts that are obligated by the eligible entity from non-Federal
sources, to the extent that—
‘‘(aa) the services are delivered in compliance with sub-
sections (d)(2) and (d)(3);
‘‘(bb) the eligible entity has reported the obligations to the
Secretary; and
‘‘(cc) the amount is not counted toward meeting the mainte-
nance of effort requirement in subsection (f).
‘‘(IV) STATE ALLOTMENTS.—The amount allotted under this sub-
clause for a State in which an eligible entity is operating a pro-
gram under this section for a fiscal year is—
‘‘(aa) the minimum matching grant allocation amount for the
fiscal year; plus
‘‘(bb)(AA) the amount (if any) by which the amount made
available under subsection (k) for matching grants for the fis-
cal year that remains after making the reservations required
by subsection (k)(2) or any other reduction required by Federal
law for the fiscal year exceeds the sum of the minimum match-
ing grant allocation amounts for all eligible entities for the fis-
cal year; multiplied by
‘‘(BB) the percentage of children in all States who have not
attained 5 years of age and are members of families with in-
come not exceeding the poverty line (as determined by the Sec-
retary on the basis of the most recently available data) that is
represented by the number of such children in the State (as so
determined).
‘‘(V) MINIMUM MATCHING GRANT ALLOCATION AMOUNT.—Subject
to subclause (VI), for purposes of subclause (IV), the minimum
matching grant allocation amount for a fiscal year is—
‘‘(aa) in the case of fiscal year 2024, $776,000;
‘‘(bb) in the case of fiscal year 2025, $1,000,000;
‘‘(cc) in the case of fiscal year 2026, $1,500,000; and
‘‘(dd) in the case of fiscal year 2027, $2,000,000.
‘‘(VI) SPECIAL RULE.—If, after making any reductions otherwise
required by law for a fiscal year, the amount made available for
matching grants under this clause for the fiscal year is insufficient
to provide the minimum matching grant allocation amount to each
eligible entity operating a program under this section for the fiscal
year, the Secretary may make a proportionate adjustment to the
minimum matching grant allocation amount for the fiscal year to
accommodate the reductions.
‘‘(ii) SUBMISSION OF STATEMENT EXPRESSING INTEREST IN ADDITIONAL
MATCHING FUNDS IF AVAILABLE.—Before the beginning of a fiscal year
for which an eligible entity desires a matching grant under this sub-
paragraph for a program operated under this section, the eligible entity
shall submit to the Secretary a statement as to whether the eligible en-
tity desires additional matching grant funds that may be made avail-
able under clause (iii) for the fiscal year.
‘‘(iii) CARRYOVER AND REALLOCATION OF UNOBLIGATED FUNDS.—
‘‘(I) IN GENERAL.—If the Secretary determines that an amount al-
lotted under clause (i)(IV) of this subparagraph for a fiscal year
will not be awarded during the fiscal year, or that an amount made
available under subsection (k)(1) for a fiscal year for matching
grants will not be obligated by an eligible entity for the fiscal year,
the amount shall be available for matching grants under this sub-
paragraph for the succeeding fiscal year for eligible entities that
have made submissions under clause (ii) of this subparagraph for
additional matching grant funds from the amount.
‘‘(II) STATE ALLOTMENTS.—The Secretary shall allot to each eligi-
ble entity that has made such a submission for a fiscal year—
‘‘(aa) the total amount (if any) made available under sub-
clause (I) for the fiscal year; multiplied by
‘‘(bb) the percentage of children who have not attained 5
years of age and are members of families with income not ex-
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ceeding the poverty line (as determined by the Secretary on
the basis of the most recently available data) in all of the
States in which any eligible entity that has made such a sub-
mission is so operating a program, that is represented by the
number of such children in the State (as so determined) in
which the eligible entity is operating such a program.
‘‘(III) ADDITIONAL MATCHING AMOUNT.—
‘‘(aa) IN GENERAL.—Subject to item (bb) of this subclause, the
additional matching amount with respect to an eligible entity
for a fiscal year is 75 percent of the sum of—
‘‘(AA) the total amount obligated by the eligible entity
for home visiting services in the State for the fiscal year,
from Federal funds made available for the fiscal year
under this subparagraph; and
‘‘(BB) the total amount so obligated by the eligible entity
from non-Federal funds, determined under clause (i)(III),
that are not taken into account in determining the matching
amount with respect to the eligible entity under clause (i).
‘‘(bb) LIMITATION.—The additional matching amount with re-
spect to an eligible entity for a fiscal year shall not exceed the
allotment under subclause (II) for the State in which the eligi-
ble entity is operating a program under this section for the fis-
cal year.’’.
(2) MAINTENANCE OF EFFORT.—Section 511(f) of such Act (42 U.S.C. 711) is
amended to read as follows:
‘‘(f) MAINTENANCE OF EFFORT.—
‘‘(1) IN GENERAL.—Notwithstanding any other provision of this section, the
Secretary may not make a grant to an eligible entity under this section for a
fiscal year if the total amount of non-Federal funds obligated by the eligible en-
tity in the State in the fiscal year for a program operated pursuant to this sec-
tion is less than the total amount of non-Federal funds reported to have been
expended by any eligible entity for such a program in the State in fiscal year
2019 or 2021, whichever is the lesser.
‘‘(2) PUBLICATION OF AMOUNTS.—Not later than June 30, 2023, the Secretary
shall cause to have published in the Federal Register the amount of non-Federal
funds expended as described in this section that has been reported by each eligi-
ble entity not referred to in subsection (k)(2)(A) for each of fiscal years 2019 and
2021.
‘‘(3) GRACE PERIOD.—The Secretary may, in exceptional circumstances, allow
an eligible entity a period to come into compliance with this subsection. The
Secretary shall provide technical assistance to any eligible entity to assist the
entity in doing so.’’.
(b) RESERVATIONS OF FUNDS FOR CERTAIN PURPOSES.—Section 511(j)(2) of such
Act (42 U.S.C. 711(j)(2)) is amended—
(1) in the matter preceding subparagraph (A), by striking ‘‘the amount’’ and
inserting ‘‘each amount made available for base grants and each amount made
available for matching grants’’;
(2) in subparagraph (A)—
(A) by striking ‘‘3’’ and inserting ‘‘6’’; and
(B) by striking ‘‘and’’ at the end; and
(3) by striking subparagraph (B) and inserting the following:
‘‘(B) 2 percent of such amount for purposes of providing technical assist-
ance, directly or through grants or contracts, for purposes as otherwise de-
scribed in subsections (c)(5), (d)(1)(C)(iii), (d)(1)(E)(iii), and (d)(4)(E);
‘‘(C) 2 percent of such amount for purposes of workforce support, reten-
tion, and case management, including workforce-related technical assist-
ance, research and evaluation, and program administration, directly or
through grants or contracts, of which the Secretary shall use not more than
$1,500,000 to establish and operate the Jackie Walorski Center for Evi-
dence-Based Case Management; and
‘‘(D) 3 percent of such amount for purposes of research and evaluation (di-
rectly or through grants or contracts), and for administering this section
(directly, through contracts, or otherwise).’’.
(c) APPROPRIATIONS.—Section 511(j)(1) of such Act (42 U.S.C. 711(j)(1)) is amended
by striking subparagraphs (A) through (H) and inserting the following:
‘‘(A) for fiscal year 2023, $500,000,000 for base grants;
‘‘(B) for fiscal year 2024, $550,000,000, of which $500,000,000 shall be for
base grants and $50,000,000 shall be for matching grants;
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‘‘(C) for fiscal year 2025, $600,000,000, of which $500,000,000 shall be for
base grants and $100,000,000 shall be for matching grants;
‘‘(D) for fiscal year 2026, $650,000,000, of which $500,000,000 shall be for
base grants and $150,000,000 shall be for matching grants; and
‘‘(E) for fiscal year 2027, $800,000,000, of which $500,000,000 shall be for
base grants and $300,000,000 shall be for matching grants.’’.
(d) DISPOSITION OF EXCESS FUNDS RESERVED FOR RESEARCH, EVALUATION, AND
ADMINISTRATION.—Section 511(j) of such Act (42 U.S.C. 711(j)) is amended by add-
ing at the end the following:
‘‘(5) DISPOSITION OF EXCESS FUNDS RESERVED FOR RESEARCH, EVALUATION, AND
ADMINISTRATION.—To the extent that the amounts reserved under paragraph
(2)(D) for a fiscal year are not obligated in the fiscal year, the Secretary may
use the funds for any purpose described in this section or to offset any reduction
with respect to this section that is required by Federal law.’’.
SEC. 4. REQUIREMENT THAT HOME VISITING PROGRAMS BE TARGETED AND INTENSIVE.
Section 511(d)(3) of the Social Security Act (42 U.S.C. 711(d)(3)) is amended by
redesignating subparagraph (B) as subparagraph (C) and inserting after subpara-
graph (A) the following:
‘‘(B) USE OF GRANT TO PROVIDE OR SUPPORT TARGETED, INTENSIVE HOME
VISITING SERVICES.—The program uses the grant to provide or support tar-
geted, intensive home visiting services for the populations described in
paragraph (5).’’.
SEC. 5. LIMITATION ON USE OF FUNDS FOR ADMINISTRATION.
(a) IN GENERAL.—Section 511(d) of the Social Security Act (42 U.S.C. 711(d)) is
amended by adding at the end the following:
‘‘(5) LIMITATION ON USE OF FUNDS FOR ADMINISTRATIVE COSTS.—
‘‘(A) IN GENERAL.—Except as provided in subparagraph (B) of this para-
graph, an eligible entity to which funds are provided under subsection (c)
or (h)(2)(B) shall not use more than 10 percent of the funds to cover the
costs of administration.
‘‘(B) AUTHORITY TO GRANT EXCEPTIONS.—
‘‘(i) IN GENERAL.—The Secretary may authorize an eligible entity that
meets a condition of clause (ii) of this subparagraph to exceed the per-
centage limitation in subparagraph (A) with respect to a program con-
ducted under this subsection by not more than 5 percentage points,
subject to such terms and conditions as the Secretary deems appro-
priate.
‘‘(ii) CONDITIONS.—An eligible entity meets a condition of this clause
if the eligible entity—
‘‘(I) conducts the program by directly providing home visits to eli-
gible families and without a sub-recipient;
‘‘(II) in the fiscal year for which the grant for the program is
made under this section, proposes to expand services in 1 or more
communities identified in the statewide needs assessment under
subsection (b) and in which home visiting services are not provided;
or
‘‘(III) has conducted the program for fewer than 3 years.’’.
(b) CONFORMING AMENDMENTS.—Section 511(i)(2) of such Act (42 U.S.C. 711(i)(2))
is amended by striking subparagraph (C) and redesignating subparagraphs (D)
through (G) as subparagraphs (C) through (F), respectively.
SEC. 6. ANNUAL REPORT TO CONGRESS.
(a) IN GENERAL.—Section 511 of the Social Security Act (42 U.S.C. 711) is amend-
ed by redesignating subsections (j) and (k) as subsections (k) and (l), respectively,
and inserting after subsection (i) the following:
‘‘(j) ANNUAL REPORT TO CONGRESS.—By December 31, 2023, and annually there-
after, the Secretary shall submit to the Congress a written report on the grants
made under this section for the then preceding fiscal year, which shall include—
‘‘(1) an eligible entity-by-eligible entity summary of the outcomes measured by
the entity with respect to each benchmark described in subsection (e)(5) that
apply to the entity;
‘‘(2) information regarding any technical assistance funded under subpara-
graph (B) or (C) of subsection (k)(2), including the type of any such assistance
provided;
‘‘(3) information on the demographic makeup of families served by each such
entity to the extent possible while respecting participant confidentiality, includ-
ing race, ethnicity, educational attainment at enrollment, household income,
and other demographic markers as determined by the Secretary;
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‘‘(4) the information described in subsection (d)(1)(E);
‘‘(5) the estimated share of the eligible population served using grants made
under this section;
‘‘(6) a description of each service delivery model funded under this section by
the eligible entities in each State, and the share (if any) of the grants expended
on each model;
‘‘(7) a description of non-Federal expenditures by eligible entities to qualify
for matching funds under subsection (c)(4);
‘‘(8) information on the uses of funds reserved under subsection (k)(2)(C);
‘‘(9) information relating to those eligible entities for which funding is re-
served under subsection (k)(2)(A), with modifications as necessary to reflect trib-
al data sovereignty, data privacy, and participant confidentiality; and
‘‘(10) a list of data elements collected from eligible entities, and the purpose
of each data element in measuring performance or enforcing requirements
under this section.’’.
(b) CONFORMING AMENDMENTS.—
(1) Section 511 of such Act (42 U.S.C. 711) is amended—
(A) in subsection (b)(1)(B)(iii), by striking ‘‘(k)(2)’’ and inserting ‘‘(l)(2)’’;
and
(B) in subsection (h)(2)(B)—
(i) by striking ‘‘(j)’’ and inserting ‘‘(k)’’; and
(ii) by striking ‘‘(k)(1)(B)’’ and inserting ‘‘(l)(1)(B)’’.
(2) Section 511A(c) of such Act (42 U.S.C. 711a(c)) is amended in each of para-
graphs (5) and (7) by striking ‘‘511(k)(2)’’ and inserting ‘‘511(l)(2)’’.
SEC. 7. REDUCTION OF ADMINISTRATIVE BURDEN.
Section 511(h) of the Social Security Act (42 U.S.C. 711(h)) is amended by adding
at the end the following:
‘‘(6) REDUCTION OF ADMINISTRATIVE BURDEN.—
‘‘(A) IN GENERAL.—The Secretary shall reduce the burden, on States and
public and private implementing agencies at the local level, of admin-
istering this section, by—
‘‘(i) reviewing and revising administrative data collection instruments
and forms to eliminate duplication and streamline reporting require-
ments for States, eligible entities referred to in subsection (k)(2)(A), and
nonprofit organizations referred to in subsection (l)(1)(B), including
timelines for submitting reports;
‘‘(ii) conducting an analysis of the total number of hours reported by
administering agencies on complying with paperwork requirements,
and exploring, in consultation with administering agencies, ways to re-
duce the number of hours spent by at least 15 percent;
‘‘(iii) conducting a review of paperwork and data collection require-
ments for tribal grantees, and exploring, in consultation with tribes
and tribal organizations, ways to reduce administrative burden, respect
sovereignty, and acknowledge the different focus points for tribal grant-
ees;
‘‘(iv) collecting input from relevant State fiscal officials to align fiscal
requirements and oversight for States and eligible entities to ensure
consistency with standards and guidelines for other Federal formula
grant programs; and
‘‘(v) consulting with administering agencies and service delivery
model representatives on needed and unneeded data elements regard-
ing the dashboards provided for in subsection (d)(1)(B), consistent with
the data requirements of such subsection.
‘‘(B) FINDINGS ON PAPERWORK REDUCTION.—
‘‘(i) INCLUSION IN REPORT.—In the 1st report submitted pursuant to
subsection (j) more than 18 months after the date of the enactment of
this Act, the Secretary shall include the findings of the Secretary with
respect to the matters described in subparagraph (A).
‘‘(ii) IMPLEMENTATION.—Within 2 years after complying with clause
(i), the Secretary shall implement the findings referred to in clause (i).’’.
SEC. 8. VIRTUAL HOME VISITING AUTHORIZATION AND RESTRICTIONS.
(a) VIRTUAL HOME VISITS.—
(1) APPLICATION REQUIREMENTS.—Section 511(e) of the Social Security Act (42
U.S.C. 711(e)) is amended by redesignating paragraph (10) as paragraph (11)
and inserting after paragraph (9) the following:
‘‘(10) At the option of the eligible entity—
‘‘(A) a description of any limitations or constraints on virtual home visits
under the program, including—
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‘‘(i) a description of the plan of the eligible entity to encourage in-per-
son home visits; and
‘‘(ii) a description of the considerations to be used in determining
when a virtual home visit is appropriate, including client consent, cli-
ent preference, geographic limitations, model fidelity, and hazardous
conditions including public health emergencies, weather events, health
concerns for home visitors and client families, and other local issues;
‘‘(B) an assurance that—
‘‘(i) the virtual home visit is implemented as a model enhancement;
or
‘‘(ii) the Secretary has identified the home visit as part of an effective
model or model adaptation, based on an evidence of effectiveness re-
view conducted using the criteria established under subsection
(d)(3)(A)(iii); and
‘‘(C) an assurance to the Secretary that at least 1 in-person home visit
shall be conducted for each client family under the program during the 12-
month period that begins with the entry of the client family into the pro-
gram, and during each succeeding 12-month period, except that any such
period in which a public health emergency declared under Federal law, or
under the law of the State in which the program is conducted, is in effect
shall be extended by the length of time in which the declaration is in ef-
fect.’’.
(2) APPLICABLE RULES.—Section 511(d) of such Act (42 U.S.C. 711(d)) is
amended by redesignating paragraph (4) and paragraph (5) (as added by section
5(a) of this Act) as paragraphs (5) and (6), respectively, and inserting after
paragraph (3) the following:
‘‘(4) VIRTUAL HOME VISITS.—
‘‘(A) IN GENERAL.—A virtual home visit conducted under the program
shall be considered a home visit for purposes of this section if the applica-
tion for funding of the program submitted pursuant to this section most re-
cently after the effective date of this paragraph includes the material de-
scribed in subsection (e)(10).
‘‘(B) STANDARDS FOR TRAINING APPLICABLE TO VIRTUAL SERVICE DELIV-
ERY.—The standards for training requirements applicable to virtual service
delivery under a home visiting model shall be equivalent to those that
apply to in-person service delivery under the model.
‘‘(C) REPORTING REQUIREMENT.—A grant made under this section for the
program may not be used for any virtual home visit during a year, unless
the eligible entity to which the grant is made submits the report described
in subsection (e)(8)(A) for the year.
‘‘(D) VIRTUAL HOME VISIT DEFINED.—In this section, the term ‘virtual
home visit’ means a visit conducted solely by use of electronic information
and telecommunications technologies.
‘‘(E) TECHNICAL ASSISTANCE.—If the Secretary finds that an eligible entity
has not complied with the assurance described in subsection (e)(10)(C), the
Secretary shall, directly or through grants, contracts, or cooperative agree-
ments, provide the eligible entity with such technical assistance as is nec-
essary to assist the eligible entity in doing so.’’.
(3) PROGRAM REQUIREMENT.—Section 511(d)(3)(C) of such Act (42 U.S.C.
711(d)(3)(C)), as so redesignated by section 4 of this Act, is amended by adding
at the end the following:
‘‘(vii) If the application submitted by the eligible entity includes the
assurance described in subsection (e)(10)(C) with respect to the pro-
gram, the program provides in-person service consistent with the assur-
ances.’’.
(4) REPORTS.—Section 511(e)(8)(A) of such Act (42 U.S.C. 711(e)(8)(A)) is
amended by inserting ‘‘, including the number of virtual home visits conducted
under the program in the year covered by the report, disaggregated with respect
to each home visiting model under which the virtual home visits are conducted’’
before the semicolon.
(b) TRANSITION RULE.—
(1) IN GENERAL.—A virtual home visit conducted before the effective date of
the amendments made by this section under an early childhood home visitation
program funded under section 511 of the Social Security Act shall be considered
a home visit for purposes of such section.
(2) VIRTUAL HOME VISIT DEFINED.—In paragraph (1), the term ‘‘virtual home
visit’’ means a visit conducted solely by use of electronic information and tele-
communications technologies.
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SEC. 9. EFFECTIVE DATE.
(a) IN GENERAL.—Except as provided in subsection (b), this Act and the amend-
ments made by this Act shall take effect on October 1, 2022.
(b) VIRTUAL HOME VISITING PROVISIONS.—The amendments made by section 8
shall take effect on October 1, 2023.
I. SUMMARY AND BACKGROUND
A. PURPOSE AND SUMMARY
The bill, H.R. 8876, ‘‘The Jackie Walorski Maternal and Child
Home Visiting Reauthorization Act of 2022,’’ as amended and or-
dered reported by the Committee on Ways and Means on Sep-
tember 21, 2022, reauthorizes the Maternal, Infant, and Early
Childhood Home Visiting program through fiscal year 2027, makes
policy improvements, and gradually increases federal funding for
evidence-based home visiting.
B. BACKGROUND AND NEED FOR LEGISLATION
The Maternal, Infant, and Early Childhood Home Visiting pro-
gram (MIECHV) funds evidence-based home visiting models that
improve familial health, well-being, and stability. It particularly fo-
cuses on child and maternal health, preventing abuse and neglect,
and supporting child development and school readiness. After an
initial ramp-up period from 2010–2013, MIECHV’s funding level
stayed at $400 million a year, but was reduced to approximately
$377 million in FY 2022 by the ongoing budget sequester.1 Con-
gress has continued MIECHV with bipartisan support several
times.2 To help address challenges specific to the pandemic, Con-
gress also provided $150 million in one-time MIECHV funding in
the American Rescue Plan Act (ARPA) (Pub. L. 117–2).3 Funding
for MIECHV was scheduled to expire September 30, 2022, but the
program was authorized through December 16, 2022, in the Con-
tinuing Resolution (Pub. L. 117–43).4
An ‘‘eligible entity’’ is designated to administer MIECHV in each
state or U.S. territory. In most cases, the eligible entity is a state
or territorial agency, but if the state or territory declines to admin-
ister the program, the Secretary may award the jurisdiction’s grant
to a qualified non-profit. Non-profit organizations currently admin-
ister MIECHV in three states: Florida, North Dakota, and South
Carolina, and previously administered the program in Wyoming.5
Some states fund MIECHV programs to serve their tribal commu-
nities, but the majority of tribal home visiting is awarded in com-
petitive grants or grant continuations funded by the tribal reserva-
1 OMB Report of the Congress on the BBEDCA 251A Sequestration for Fiscal Year 2022, THE
WHITE HOUSE (May 28, 2021), https://www.whitehouse.gov/wp-content/uploads/2021/05/
BBEDCA_251A_Sequestration_Report_FY2022.pdf.
2 Protecting Access to Medicare Act of 2014, Pub. L. 113–93; Medicare Access and CHIP Reau-
thorization Act of 2015, Pub. L. 114–10; Bipartisan Budget Act of 2018, Pub. L. 115–123.
3 American Rescue Plan Act of 2021, Pub. L. No. 117–2.
4 Extending Government Funding and Delivering Emergency Assistance Act, Pub. L. No. 117–
43.
5 Admin. For Children and Families, FY 2022 Maternal, Infant, and Early Childhood Home
Visiting Awards, U.S. DEPT. OF HEALTH & HUMAN SERVS., https://mchb.hrsa.gov/programs-
impact/programs/home-visiting/fy-2022-miechv-awards (last visited Oct. 11, 2022).
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tion. Thirty tribes or tribal organizations currently operate pro-
grams funded by tribal MIECHV grants.6
MIECHV is a model federal program in that it directs funding
to interventions that have demonstrated that they improve out-
comes for families. Eligible entities and tribal MIECHV programs
can only receive funding if they operate a home visiting program
that has been evaluated (or, in specific, limited cases, is under
evaluation) and has shown positive impacts in relevant measures
of family and child well-being, based on a review by the U.S. De-
partment of Health and Human Services (HHS). States use
MIECHV grants to select among 19 models that meet a specified
evidence threshold. These 19 models have been rigorously evalu-
ated to demonstrate significant, positive outcomes in areas such as
reducing child abuse and neglect, improving maternal and child
health, and improving family stability.
The models pair a home visitor (depending on the model, this
may be a peer educator, a social worker, a nurse, or some other in-
dividual with specialized training) with a client family that meets
the program’s qualifications for enrollment. For example, some
models serve only first-time parents or only enroll families pre-
natally, at birth, or work only with specific-aged young children.
The home visitor then follows a specific curriculum designed to
help the type of family the program enrolls. Some common out-
comes of home visiting programs include improving maternal
health before and after birth, teaching positive parenting skills, en-
couraging pre-literacy activities, connecting families to medical
homes, screening for depression, and referring families to other
needed services to help support and stabilize the family. Eligible
entities must concentrate the services in areas identified in a rig-
orous needs assessment based on parameters for need appropriate
to that state or territory.7
Participant families and local programs report that MIECHV is
life changing for parents and children who need extra support.
Erica Beck, a home visiting participant mother from Chicago, IL,
testified at the Subcommittee on Worker and Family Support’s
March 2022 hearing. She said, ‘‘I know that our lives are changed
forever and for the better because of Myia [our home visitor] . . .
For parents—moms or dads—that want and need this kind of sup-
port, it should be there for them.’’ 8 Debie Coble, President and
CEO of Goodwill Industries of Michiana, shared about a mother
named Daisy at the same hearing. She said, ‘‘[Daisy’s] Nurse-Fam-
ily Partnership nurse encouraged her to enroll at the Excel Center
to obtain her high school diploma and achieve her education goal.
Daisy was the first in her family to graduate from high school . . .
We are so proud of Daisy and the work and dedication she put in
to achieving her diploma, full-time employment, and being a great
mom to her son.’’ 9
6 Admin. For Children and Families, Tribal Home Visiting Grantees, U.S. DEPT. OF HEALTH
& HUMAN SERVS., https://www.acf.hhs.gov/ecd/tribal/tribal-home-visiting/thv-grantees (last vis-
ited Oct. 11, 2022).
7 42 U.S.C. § 711(d)(4).
8 Improving Family Outcomes through Home Visiting: Hearing Before the Subcomm. on Work-
er and Family Support of the H. Comm. on Ways and Means, 117th Cong. (2022) (Statement
of Erica Beck, Healthy Families America Program Participant at the Henry Booth House).
9 Improving Family Outcomes through Home Visiting: Hearing Before the Subcomm. on Work-
er and Family Support of the H. Comm. on Ways and Means, 117th Cong. (2022) (Statement
of Debie Coble, President and CEO of Goodwill Industries of Michiana, Inc.).
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The cost per home visiting client family varies widely based on
location and model implemented, but generally ranges from $4,000
to $10,000 per year.10 Home visiting programs have recently expe-
rienced challenges like high turnover, increased staff burnout, and
issues in hiring due to rising workforce costs and the effects of the
pandemic. In the current economic environment, home visiting
agencies also have reported difficulty recruiting and retaining
qualified staff. Lack of adequate pay has forced qualified and expe-
rienced home visitors out of these challenging jobs toward lower-
stress jobs that pay better.11 The Mother and Infant Home Visiting
Program Evaluation (MIHOPE) identified the quality of staff as
one of the keys to a successful home visiting program.12
States and territories may only use MIECHV grants to fund a
home visiting model or models that meet a high standard of proven
effectiveness and meet the standards of the Home Visiting Evi-
dence of Effectiveness (HomVEE) review, or in limited cases, a
promising practice that is being rigorously evaluated.13 Home vis-
iting agencies currently have the choice of 19 HomVEE-approved
models for service delivery that meet the evidence standard and
other requirements of the program, though most use one or more
of the three largest models—Parents as Teachers, Nurse-Family
Partnership, and Healthy Families America.14 States also have the
option of using up to 25 percent of their funds for ‘‘promising’’ ap-
proaches not yet available in HomVEE, but if they choose that op-
tion, they must also rigorously evaluate the model while delivering
services. Three states (Arizona, Arkansas, and Kansas) currently
use MIECHV funds to test such ‘‘promising models.’’ Tribal pro-
grams are allowed to make adaptations to existing models to fit
tribal culture and are also required to do additional research.15
MIECHV created a strong incentive for states to increase the use
of evidence-based home visiting models, both by tying funding to
use of already-proven models and by allowing them to use up to 25
percent of funding for promising models that are being rigorously
evaluated. At the time of initial enactment, seven models met
HomVEE evidence standards. Today, that number has grown to
19.16 In 2015, MIHOPE found that many states funded home vis-
iting programs that were not evidence-based prior to MIECHV, in
addition to funding evidence-based models.17 The majority of states
used MIECHV funding to expand the operation of existing evi-
10 Admin. For Children and Families, What is Home Visiting Evidence of Effectiveness?, U.S.
DEPT. OF HEALTH & HUMAN SERVS., https://homvee.acf.hhs.gov (last visited Sept. 19, 2022).
11 Improving Family Outcomes through Home Visiting: Hearing Before the Subcomm. on
Worker and Family Support of the H. Comm. on Ways and Means, 117th Cong. (2022) (State-
ment of Steven Pascal, Director of Home Visiting for The Children’s Trust).
12 OFFICE OF PLANNING, RESEARCH AND EVALUATION, ADMIN. FOR CHILDREN AND FAMILIES,
U.S. DEPT. OF HEALTH & HUMAN SERVS., OPRE Report 2015–11, THE MOTHER AND INFANT
HOME VISITING PROGRAM EVALUATION (Jan. 2015).
13 Admin. For Children and Families, What is Home Visiting Evidence of Effectiveness?, supra
note 10.
14 Admin. For Children and Families, Models eligible for Maternal, Infant, and Early Child-
hood Home Visiting (MIECHV) funding, U.S. DEPT. OF HEALTH & HUMAN SERVS., https://
homvee.acf.hhs.gov/HRSA-Models-Eligible-MIECHV-Grantees (last visited Sept. 19, 2022).
15 Admin. For Children and Families, About Tribal Home Visiting, U.S. DEPT. OF HEALTH &
HUMAN SERVS., https://www.acf.hhs.gov/ecd/tribal/tribal-home-visiting/about-tribal-home-visiting
(last visited Oct. 12, 2022).
16 Admin. For Children and Families, Mother and Infant Home Visiting Program Evaluation
(MIHOPE), U.S. DEPT. OF HEALTH & HUMAN SERVS., https://www.acf.hhs.gov/opre/project/
mother-and-infant-home-visiting-program-evaluation-mihope-2011-2021 (last visited Sept. 19,
2022).
17 OFFICE OF PLANNING, RESEARCH AND EVALUATION, OPRE Report 2015–11, supra note 12.
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dence-based programs in the state, while some funded new evi-
dence-based programs. Massachusetts, for example, has used
MIECHV funding to expand from using only one evidence-based
model before MIECHV to using up to three.18
The COVID–19 pandemic made in-person service delivery chal-
lenging for MIECHV programs at a time when many families were
struggling and in need of services. To deal with the changing cir-
cumstances, many programs pivoted to new service delivery meth-
ods and issued updated guidance 19 to home visitors. Many service
delivery models implemented model enhancements as part of their
continuous quality improvement process and trained their home
visitors on best practices for administering virtual visits. States re-
ported success with this method. For example, Virginia reported a
variety of positives in their evaluation of virtual home visits, in-
cluding flexible connection methods and more contact with home
visitors.20
Eligible entities also report that very extensive administrative
procedures and data collection make it challenging for them to stay
within the statutory limit of 10 percent of funding for administra-
tive costs. Entities report being required to provide data that is not
related to program outcomes or useful for program administration
and must follow fiscal practices that are very different from how
other federal grants to states are managed and monitored. As a re-
sult, program staff often defer work to plan, support professional
development, provide programmatic support, and monitor service
quality in order to do administrative paperwork or respond to fed-
eral requests for documentation and revision, and states are unable
to follow statewide fiscal processes for MIECHV. Eligible entities
are required to fill out multiple forms, some with duplicate data,
on a quarterly basis, including very detailed expenditure reporting
for every individual home visiting site and other data not used for
program management. In some cases, entities are required to pro-
vide additional information in timeframes as short as 48 hours. Ad-
ministrators have also reported a significant mismatch between
agency estimations of completion times and the actual time re-
quired for the reports. For example, one state with a MIECHV
budget of $10 million reported spending the equivalent of 10.5
weeks to collect data and fill out a form that the agency expects
to take 18 hours.21 The collected data is not made public or regu-
larly reported to Congress.
C. LEGISLATIVE HISTORY
Background
H.R. 8876 was introduced on September 19, 2022 and was re-
ferred to the Committee on Ways and Means and additionally to
the Committee on Energy and Commerce.
18 Improving Family Outcomes through Home Visiting: Hearing Before the Subcomm. on
Worker and Family Support of the H. Comm. on Ways and Means, 117th Cong. (2022) (State-
ment of Steven Pascal, Director of Home Visiting for The Children’s Trust).
19 States Modify Home Visiting Services in Response to COVID–19, ZERO TO THREE, https://
www.zerotothree.org/resource/states-modify-home-visiting-services-in-response-to-covid-19/ (last
visited Oct. 11, 2022).
20 HEEJU JANG-PAULSEN ET AL., UNDERSTANDING THE EXPERIENCE OF VIRTUAL HOME VISITING
DURING COVID–19: FINDINGS FROM SURVEYS OF PARTICIPATING FAMILIES AND SERVICE PRO-
VIDERS 14 (Virginia Department of Social Services Division of Research and Planning, 2022).
21 Letter from ASTHVI members to Four Corners (June 22, 2022) (on file with author).
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Committee hearings
On March 16, 2022, the Subcommittee on Worker and Family
Support held a hearing titled ‘‘Improving Family Outcomes through
Home Visiting.’’ The hearing focused on the positive outcomes that
MIECHV achieves for families, as well as the challenge of pro-
viding high-quality services to families in need at current funding
levels. The witnesses were Steven Pascal, Director of Home Vis-
iting for The Children’s Trust; Myia Smith, a Healthy Families
America Family Support Specialist at the Henry Booth House;
Erica Beck, a Healthy Families America Program Participant at
the Henry Booth House; Angela Dancer, Senior Director, Home Vis-
itation Services for the Choctaw Nation of Oklahoma; and Debie
Coble, President and CEO of Goodwill Industries of Michiana, Inc.
Committee action
The Committee on Ways and Means marked up H.R. 8876, ‘‘The
Jackie Walorski Maternal and Child Home Visiting Reauthoriza-
tion Act of 2022,’’ on September 21, 2022, and ordered the bill, as
amended, favorably reported (with a quorum being present) by a
vote of 41 yeas and 0 nays.
II. EXPLANATION OF THE BILL
A. THE JACKIE WALORSKI MATERNAL AND CHILD HOME VISITING
REAUTHORIZATION ACT OF 2022
Section 1: Short title
CURRENT LAW
No provision.
EXPLANATION OF PROVISION
This section provides the short title, ‘‘The Jackie Walorski Mater-
nal and Child Home Visiting Act of 2022.’’
REASONS FOR CHANGE
The Committee believes the title accurately reflects the content
of the bill and the late Congresswoman Walorski’s key role in
crafting a bipartisan agreement. As Ranking Member of the Work-
er and Family Support Subcommittee, Representative Jackie
Walorski (R–IN), was a champion of the MIECHV program in her
state, called Healthy Families Indiana, and worked closely with
Subcommittee Chair Davis to develop many of the key provisions
in the bill. During a Subcommittee hearing held on March 16,
2022, Rep. Walorski said, ‘‘MIECHV is a program that gets results.
It works. We know this because the program builds upon decades
of scientific research showing that home visits by a nurse, social
worker, early childhood educator, or other trained professional dur-
ing pregnancy and in the first years of a child’s life helps prevent
child abuse and neglect, supports positive parenting, improves ma-
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ternal and child health, and promotes child development and school
readiness.’’ 22
Section 2. Outcomes dashboard
CURRENT LAW
Current law requires entities that receive federal funding to ad-
minister state, tribal, or territorial MIECHV programs to report in-
dividual and family outcomes related to the following benchmarks
to the Secretary of Health and Human Services (hereafter referred
to as ‘‘the Secretary’’):
• Improved maternal and newborn health;
• Prevention of child injuries, child abuse, and neglect or
maltreatment, and reduction of emergency department visits;
• Improvement in school readiness and achievement;
• Reduction in crime or domestic violence;
• Improvement in family economic self-sufficiency; or
• Improvements in the coordination and referrals for other
community resources and supports.
The Secretary may publish or share relevant data but is not re-
quired to regularly provide the reported information to Congress or
make it public.
EXPLANATION OF PROVISION
This section requires the Secretary to establish and operate a
website accessible to the public that includes annually updated and
easy-to-understand information on outcomes achieved by state or
territory MIECHV programs (including programs administered by
nonprofit entities instead of the state). The Secretary may operate
the website directly or via grants or contracts.
The dashboard must convey outcomes for states and territories
(including those operated by a non-profit, i.e., ‘‘eligible entity’’)
using a template that includes:
• A profile for each entity showing outcome indicators and
how they compare to the benchmarks established for those out-
comes;
• Information on the outcome indicators and requisite out-
come levels for each entity;
• Information on the evidence-based home visiting model(s)
used by the entity and specific participant outcomes the model
is intended to affect;
• The most recently available information reported in the re-
port on performance improvement;
• An electronic link to the state needs assessment, which
identifies high-need communities for MIECHV services; and
• Information regarding any penalty or other corrective ac-
tion taken by the Secretary against an entity and, if the entity
is operating under a corrective action plan, detailed informa-
tion about the plan and progress toward improvement.
The section also requires the Secretary to provide similar infor-
mation for tribal grantees, with adjustments to protect tribal sov-
22 Improving Family Outcomes through Home Visiting: Hearing Before the Subcomm. on
Worker and Family Support of the H. Comm. on Ways and Means, 117th Cong. (2022) (State-
ment of Rep. Jackie Walorski, Subcomm. Ranking Member).
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ereignty and data privacy, and to ensure the dashboard preserves
confidentiality of participant families.
REASON FOR CHANGE
While MIECHV is a program centered on using interventions
which have been demonstrated to improve specific maternal, child,
and family outcomes in rigorous research studies, data provided to
Congress and the public is primarily focused on inputs like number
of visits, screenings, and referrals to other services, without linking
those inputs to individual and family outcomes. Data is also not
regularly or comprehensively shared with Congress or the public.
As a result, we lack data about the impact of interventions funded
by the federal program. The new outcomes dashboard will allow
Congress, beneficiary advocates, stakeholders, researchers, and tax-
payers to monitor the impacts of MIECHV investment in states,
territories, and tribal communities. The Committee intends this
provision to improve visibility into program results by creating a
regularly updated, easy-to-read, state-by-state, online dashboard of
MIECHV performance measures and clinical indicators to show ac-
tual impact on maternal, family, and child outcomes. The dash-
board should be adjusted to accommodate different model types
since states use different models focused on impacting different
outcomes.
Section 3. Funding
CURRENT LAW
A pro rata share of $400 million, which was the amount of fund-
ing provided for MIECHV in fiscal year 2022, is available to oper-
ate the MIECHV program through December 16, 2022. Annual
funding was $100 million in fiscal year 2010, $250 million in fiscal
year 2011, $350 million in fiscal year 2012, and $400 million in fis-
cal years 2013–2022.
The Secretary is required to reserve three percent of funding for
grants to tribal home visiting programs and three percent for re-
search, evaluation, and assisting eligible entities to demonstrate
improvements in benchmark outcomes.
The Secretary is authorized to use the remainder of funds to
make grants to eligible entities to fund qualified home visiting
services, provide technical assistance, or expend for other purposes
consistent with the three purposes of Section 511, which are: (1)
strengthening and improving evidence-based early childhood home
visiting; (2) improving coordination of services to at-risk commu-
nities; and (3) identifying at-risk families and providing them with
comprehensive services to improve outcomes.
Eligible entities are required to maintain prior state/territory-
wide spending levels for MIECHV-administered home visiting
(‘‘maintenance of effort, or MOE’’) and not reduce that spending or
replace it with federal dollars (‘‘supplantation’’).
Grant size, duration, and allocation of funding among purposes
and eligible entities are at the discretion of the Secretary and have
varied from year to year based on that discretion. The Health Re-
sources and Services Administration (HRSA), which administers
MIECHV, reports that in an average year, it spends roughly an ad-
ditional three to five percent of funding on additional technical as-
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sistance and administrative expenses. Between fiscal years 2021
and 2022, federal funding was constant but grant amounts in-
creased for 15 eligible entities and declined for the remaining 41.
EXPLANATION OF PROVISION
This section provides funding for MIECHV in fiscal years 2023
through 2027 and specifies how it is to be allocated among eligible
entities and program purposes, including providing statutory for-
mulas to allocate the majority of funding to states and territories.
The funding levels are:
• FY 2023: $500 million for base grants (total $500 million);
• FY 2024: $500 million for base grants, and $50 million for
matching grants (total $550 million);
• FY 2025: $500 million for base grants, and $100 million for
matching grants (total $600 million);
• FY 2026: $500 million for base grants, and $150 million for
matching grants (total $650 million); and
• FY 2027: $500 million for base grants, and $300 million for
matching grants (total $800 million).
Funding reservations
Thirteen percent of total funds are reserved for purposes other
than formula base and matching grants to eligible entities. The res-
ervation percentages are applied equally and deducted from the
total available appropriation, which includes base grant and match-
ing grant allocations for each fiscal year, before the base and
matching grant formulas are applied. Those reservations are:
• 6 percent for grants to Indian tribes (including consortia of
tribes), tribal organizations, or urban Indian organizations;
• 2 percent for technical assistance to states, tribes, and ter-
ritories;
• 2 percent for workforce support, retention, and case man-
agement; and
• 3 percent for HHS costs related to administering the pro-
gram, research, and evaluation activities.
The reserved funding may be used directly by the Secretary or
awarded to other entities using grants or contracts.
Of the funding reserved for workforce support, retention, and
case management, up to $1.5 million per year is to be used to cre-
ate and operate the Jackie Walorski Center for Evidence-Based
Case Management, and the remainder may be used for technical
assistance, direct grants to support the home visiting workforce,
and research.
Formula grants to eligible entities
To qualify for and receive base and matching grants, eligible en-
tities must maintain total statewide expenditures (‘‘maintenance of
effort,’’ or MOE) for the MIECHV program at the lesser of the level
previously reported for state fiscal year 2019 or state fiscal year
2021. Not later than June 30, 2023, the Secretary must publish
those amounts. The MOE requirement is not a measure of which
specific sites are funded within a state, and shifting which sites are
funded with federal dollars and which sites are funded with state
dollars would not be considered supplantation or a reduction in
MOE. In exceptional circumstances, the Secretary may provide an
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17
eligible entity that fails to meet the MOE requirement with a grace
period to come back into compliance and may provide technical as-
sistance to the entity to assist in coming into compliance.
Federal base grants. Starting in fiscal year 2023, and each year
through fiscal year 2027, every eligible entity qualifies for a federal
base grant, which is calculated in fiscal year 2023 and remains the
same in subsequent years. If the eligible entity changes during the
2023–2027 period (for example, a non-profit takes over from a
state, or vice versa), the new eligible entity for that state or terri-
tory receives the same base grant as the previous entity estab-
lished fiscal year 2023.
The federal base grant amount is calculated by first reducing the
amount available for base grants to account for reserved amounts
and any required budget sequester. The remainder is allocated by
determining each state or territory’s share of children under age
five in the U.S. and providing a proportionate share of federal base
funds, unless that would result in a more than 10 percent increase
or decrease over the state or territory’s fiscal year 2021 award. If
that occurs, the Secretary is required to adjust the amount to stay
within those guardrails, and any funds remaining after the guard-
rail adjustments are distributed to states and territories on a pro
rata basis, with a minimum grant award of $1 million. If necessary
to achieve the $1 million minimum, the Secretary may make pro
rata adjustments in other grant amounts.
Federal matching grants. Starting in fiscal year 2024, and each
year through fiscal year 2027, federal matching grant funds are
made available to every eligible entity up to a specified allocation
based on the entity obligating non-federal matching funds, as de-
fined.
The maximum federal matching grant amount for each entity in
each year is calculated by first reducing the amount available for
matching grants to account for reserved funding amounts and any
required sequester. The remaining funding is then allocated by
first providing a minimum amount, which is specified in the law,
to each eligible entity. That amount is $776,000 in fiscal year 2024,
$1 million in fiscal year 2025, $1.5 million in fiscal year 2026, and
$2 million in fiscal year 2027. If the total amount were to be insuf-
ficient to provide the full minimum amount to each eligible entity,
the Secretary is authorized to make a pro rata adjustment.
Once the minimum amount is allocated to each entity, the re-
maining funding is allocated according to the state or territory’s
share of children under five in the U.S. who are at or below the
federal poverty level.
In order to draw down its full allotment of federal matching
grant funds, an entity must provide non-federal funds above their
maintenance of effort requirement such that 25 percent of the com-
bined federal and non-federal spending consists of non-federal
funds (i.e., matching funds are available such that for every $4
spent, $3 is federal and $1 dollar is non-federal). Eligible entities
that provide less than the amount of non-federal funds needed for
the full allotment will receive federal funding proportionate to the
amount of non-federal funding provided.
To qualify as ‘‘non-federal funds’’ for the purpose of receiving fed-
eral matching funds, the entity must demonstrate that funds have
been obligated to support home visiting that are not being counted
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as part of the entity’s MOE requirement and meet the MIECHV
statutory requirements related to individual and family outcomes,
evidence, and providing targeted, intensive services. These funds do
not have to be administered by the state MIECHV agency, and
may come from state appropriations or other state funding sources,
local governments, or private entity contributions or expenditures
in coordination with the state. As with federal funds, up to 25 per-
cent of the funds may be used for new and promising approaches
to home visiting which have not yet met the MIECHV evidence
standard but are being rigorously evaluated.
Any unobligated federal matching funds in a fiscal year (i.e.,
matching fund allocations not awarded or not fully obligated by a
state) may be redistributed to eligible entities willing to provide the
required non-federal match in the following fiscal year. Those enti-
ties are required to notify the Secretary of their interest in reallo-
cated funds at the beginning of the fiscal year in which the funds
were originally appropriated. Qualified entities will receive a share
of the reallocated funds proportionate to the state or territory’s
share of children under age five in the U.S. who are below the fed-
eral poverty level among the group of states that apply and must
provide additional non-federal funds to match them in the specified
proportion (75 cents out of each dollar of combined expenditure).
All formulas in this section are to be calculated using the most
recently available data, which, in some cases, may require using a
different data source for territories than for states.
REASON FOR CHANGE
Providing five years of rising funding and allocating it consist-
ently and transparently will allow for well-planned and consistent
investments in state and territory MIECHV programs, tribal
MIECHV, research, technical assistance, coordination of services,
and the home visiting workforce. The Committee believes this pre-
dictable, targeted approach will increase the number of families
served, increase state participation and funding support through
the additional funding provided for matching, build on the high
quality of home visiting services and coordination with existing
state programs, and maintain MIECHV’s strong focus on evidence-
based approaches.
Under current law, MIECHV grants are currently distributed to
eligible entities primarily based on a funding formula developed in
policy by the HRSA, but also via competitive grants for specific
purposes at the Secretary’s discretion. The Secretary also retains
discretion to determine the portion of MIECHV funding used for re-
search and program administration. The current state and territory
formula, updated in 2018, allocates two-thirds of HRSA allocated
funds to grant funding based on state receipt of competitive grants
between 2013 and 2015, and the remaining third based on the
number of poor children under age five in the state. The formula
also ensures that no state’s grant changes by more than five per-
cent each year, which has blunted what would otherwise be signifi-
cant funding cuts in many states that were not successful in the
relevant competitive grant period and in smaller states.23 In fiscal
23 Health Resources and Services Administration policy guidance.
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19
year 2022, many states received a decreased award amount even
though the overall funding for the program was unchanged.24
This section enhances funding predictability and stability by es-
tablishing Congressional domain over both the mechanism for dis-
tributing funding as formula grants and the allocation formula by
adding language to the statute establishing base grants and match-
ing funds. The combination of base and matching funds ensures
that every state and territory can grow its home visiting programs,
while also providing a strong incentive for jurisdictions to make ad-
ditional investments in evidence-based programs and evaluating
new and promising approaches. Federal matching funds are in-
tended to increase state engagement, as well as provide additional
funding for expanding services to families. Having local dollars as
part of the pool of funding available for evidence-based home vis-
iting creates incentives for states to better coordinate programs op-
erating in the state and ensure rigorous oversight of funds.
The matching fund allocations provided under the section are
also targeted to the amount of need by allocating to states based
on the proportion of children under five in poverty. The section al-
lows states to draw down its allocation of matching funds propor-
tionate to the state’s own spending so that funding is dialed up (up
to the maximum allotment) or down relative to the overall match-
ing rate such that federal funds constitute not more than 75 per-
cent of total spending. The bill’s definition of non-federal funding
available for the match is carefully designed to support the growth
of home visiting programs, which meet the high MIECHV evidence
standard, and to align with federal MIECHV requirements related
to program design, quality, and service delivery. It also allows con-
tributions from state and local government, as well as the private
sector, non-profits, and community based organizations, and
incentivizes them to focus their investments on evidence-based ap-
proaches.
The Department of Health and Human Services estimated that
MIECHV served 15 percent of families that were eligible and in
need of home visiting services in fiscal year 2021.25 The Committee
expects that these changes in funding amounts and structure will,
over time, meet more of the need while continuing MIECHV’s high
service quality.
The Committee also expects that the substantial increase in the
reservation for tribal communities (from three percent to six per-
cent) will result in an increase in both the number of successful
tribal community applications for MIECHV grants and the size of
current grants to effective programs. This increase will provide sta-
ble funding to expand the current successful approach while re-
specting tribal sovereignty.
Since the program’s inception, funding reserved for tribal
MIECHV has allowed HHS to fund fewer than one-third of total
applications and just over one-half of highly-qualified applicants
(those scoring over 70). Tribal administrators also report that many
tribal communities have also chosen not to apply for funding be-
24 Health Resources and Services Admin., FY 2022 Maternal, Infant, and Early Childhood
Home Visiting Awards, U.S. DEPT. OF HEALTH & HUMAN SERVS., https://mchb.hrsa.gov/
programs-impact/programs/home-visiting/fy-2022-miechv-awards (last visited Oct. 3, 2022).
25 Health Resources and Services Admin., The Maternal, Infant, and Early Childhood Home
Visiting Program Brief, U.S. DEPT. OF HEALTH & HUMAN SERVS., https://mchb.hrsa.gov/sites/
default/files/mchb/about-us/program-brief.pdf (Sept. 2022).
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cause they know funding is capped, and they would receive new
funding at the expense of other tribal communities currently oper-
ating MIECHV programs.26
The Committee also expects that the new reservation for work-
force support, retention, and case management will provide for a
robust new technical assistance center named for our colleague,
Jackie Walorski. This technical assistance center will develop evi-
dence-based approaches to case management and help eligible enti-
ties use them. The reservation will also provide for additional tech-
nical assistance, grant funding, and research to support the criti-
cally important home visiting workforce. As Ranking Member of
the Ways and Means Worker and Family Support Subcommittee,
Representative Walorski believed strongly in the importance of
case management and the MIECHV program as a high-mark and
example of successful, results-driven, evidence-based policymaking.
The Committee intends for this center to focus on development and
evaluation of evidence-based case management practices for use by
states and other non-profit entities implementing MIECHV. A
strength of the MIECHV program is its reliance on meaningful in-
person interactions between families and qualified, trained home
visitors. Home visitors need a wide-ranging skill set and are re-
sponsible for broad case management which ranges across family
engagement strategies, understanding of clinical indicators of ma-
ternal depression, monitoring of child development milestones,
breastfeeding best practices, screening for domestic violence and
child abuse, and establishing linkages with critical referral services
that meet the unique needs of each family. This technical assist-
ance center would be focused on evaluating best practices for effec-
tive case management in relation to the home visiting program to
strengthen the program’s impact on improving outcomes for vulner-
able families and children.
Finally, the Committee expects the Secretary to be able to reduce
some federal administrative costs by modifying data reporting and
oversight to be more consistent with other federal formula grant
programs, with a primary focus on program outcomes and compli-
ance with statutory requirements and less focus on very detailed
financial accounting within the amount of administrative spending
allowed under the statute. Specifically, regarding financial manage-
ment and oversight, the Committee intends the Department to
align practices and reporting with that of other federal formula-
grant programs consistent with OMB guidance. Several states
brought to our attention that fiscal oversight and monitoring was
more akin to that of treating the state as a sub-contractor or sub-
grantee, thus triggering extensive and detailed financial reporting.
For example, one state described needing to seek prior HRSA ap-
proval for issuing a competitive Request for Proposal (RFP) to
allow a local agency to expand services, which took six months to
obtain.
26 Improving Family Outcomes through Home Visiting: Hearing Before the Subcomm. on
Worker and Family Support of the H. Comm. on Ways and Means, 117th Cong. (2022) (State-
ment of Angela Dancer, Senior Director, Home Visitation Services for the Choctaw Nation of
Oklahoma).
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Section 4. Requirement that home visiting programs be targeted and
intensive
CURRENT LAW
MIECHV grants must be used for program purposes (strength-
ening, coordinating, and providing services to at-risk communities).
More specifically, grants must be used to support early childhood
home visitation programs that make quantifiable, measurable im-
provements in individual and family outcomes in specified areas
and demonstrate those improvements in reports to the Secretary.
Service delivery must be a core component of the eligible entity’s
use of funds, and the funded models must adhere to a clear, con-
sistent model that meets a rigorous-evidence standard; employs
well-trained, competent, and well-supervised staff; coordinates with
other programs that serve the target population; and monitors fi-
delity to the evidence-based model. The one exception to the evi-
dence requirement is that a maximum of 25 percent of total funds
may be used for new and promising approaches which have not yet
met the MIECHV evidence standard but are being rigorously eval-
uated.
Eligible entities are also required to give priority to serving high-
risk populations, as identified in a state or territory-wide needs as-
sessment.
EXPLANATION OF PROVISION
This section clarifies that the core component service delivery
funded by MIECHV should be targeted, intensive services provided
to at-risk populations.
REASON FOR CHANGE
The Committee wished to clarify that although eligible entities
can and may use a minority of their non-administrative funding for
program infrastructure costs that support effective coordination
and service delivery, including promoting integration of home vis-
iting with other early childhood systems and operating universal or
targeted intake programs, the primary focus of the MIECHV pro-
gram is targeted, intensive home visiting programs which identify
at-risk expectant parents and families and provide ongoing services
to them to improve family outcomes.
Section 5. Limitation on use of funds for administration
CURRENT LAW
Eligible entities are limited to spending a maximum of 10 per-
cent of their federal funding to administer their programs by a pro-
vision in Section 504 of the Social Security Act, which governs all
programs within the Title V of the Social Security Act.
EXPLANATION OF PROVISION
The section de-links the 10 percent limitation on administrative
funding from the rest of the Maternal and Child Health Block
Grant, which is outside of the Committee’s jurisdiction, and creates
a MIECHV-specific 10 percent rule. It also allows the Secretary to
grant exceptions which increase the allowable share to a maximum
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22
of 15 percent in three specific circumstances in which higher ad-
ministrative costs might be expected: (1) if the eligible entity has
no sub-contractors, (2) if the eligible entity is in the process of ex-
panding to new communities, or (3) if the eligible entity is new to
administering MIECHV.
REASON FOR CHANGE
The Committee wanted to ensure that the administrative limita-
tion remained constant unless the MIECHV law specifically was
changed; one that could not be altered by a change intended for a
different program (the Maternal and Child Health Block Grant).
Section 6. Annual report to Congress
CURRENT LAW
The Secretary is not specifically required to provide a regular
written report or other information to Congress about MIECHV op-
erations or program outcomes.
EXPLANATION OF PROVISION
This section requires the Secretary to provide a written report to
Congress on the MIECHV program starting with fiscal year 2023,
and to provide the report annually thereafter. The report must in-
clude:
• Information for all states and territories on the outcomes
achieved and how they compare to applicable statutory bench-
marks;
• Information regarding technical assistance provided to
grantees;
• Information on the demographic makeup of families
served;
• Information that states, territories, and non-profits report
in their demonstration of improvement report to HHS, in the
years in which that information is available;
• Information on the estimated share of the eligible popu-
lation receiving home visiting from MIECHV;
• A description of the service delivery models funded in each
state or territory and the share of grants used for each model;
• A description of non-federal funds used to meet match re-
quirements;
• Information on uses of funds reserved for workforce sup-
port, retention, and case management, including the Jackie
Walorski Center for Evidence-Based Case Management;
• Information relating to tribal home visiting programs; and
• A list of data elements that HHS requires eligible entities
to report, and the purpose and use of each element.
REASON FOR CHANGE
The Committee believes that an annual report on the MIECHV
program would allow for better program oversight by Congress and
limit our need to make repeated requests to the Secretary for spe-
cific program data. An annual report to Congress will facilitate in-
creased congressional engagement and provide the Committee with
information needed to assess how the program is working and
areas for improvement or changes in the future.
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Section 7. Reduction of administrative cost
CURRENT LAW
No provision.
EXPLANATION OF PROVISION
This section requires the Secretary to reduce the administrative
burden of MIECHV data reporting and compliance with federal
rules in a way that focuses more resources on families, while main-
taining accountability. Under this section, the Secretary must re-
view current data collection tools and procedures, conduct an anal-
ysis of the number of hours required to comply with federal paper-
work, and explore ways to reduce hours spent by at least 15 per-
cent. The Secretary must also work with tribal grantees to ensure
that their requirements are appropriate and respect tribal sov-
ereignty and consult state fiscal officials to ensure consistency with
financial requirements in other federal formula grant programs.
REASON FOR CHANGE
Eligible entities report devoting very substantial staff resources
to collecting and compiling detailed data required by the Secretary,
including site-level financial reporting that is unusual for federal
grant programs and not required by the statute or related to indi-
vidual or family outcomes. As the program shifts from one that pri-
marily made competitive grant awards to one in which funding is
consistently distributed by formula to states and territories, the
Committee believes there is an opportunity to reduce the share of
funding allocated to administration at both the eligible entity and
federal level, while maintaining accountability for achieving pro-
gram outcomes and staying within statutory limitations on admin-
istrative spending.
Section 8. Virtual home visiting authorization and restrictions
CURRENT LAW
No provision. The Consolidated Appropriations Act, 2021 (Pub. L.
116–260) provided emergency flexibility in response to the COVID–
19 pandemic and allowed home visiting funds to be used to serve
families through virtual visits until September 30, 2022.
EXPLANATION OF PROVISION
This section authorizes the use of virtual visits and adds restric-
tions to their use.
Beginning in fiscal year 2024, eligible entities will have the op-
tion to provide additional information to the Secretary dem-
onstrating that they have met specific conditions and then will be
allowed to utilize virtual visits in specific situations under those
conditions. All service delivery models must include at least one in-
person visit a year to qualify for federal funding. Entities that wish
to provide limited virtual visits must provide the Secretary with:
• A description of limitations or constraints on virtual home
visits, including:
» A description of the plan of the eligible entity to en-
courage in-person home visits; and
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» A description of the considerations to be used in de-
termining when a virtual home visit is appropriate, includ-
ing client consent, client preference, geographic limita-
tions, model fidelity, hazardous conditions (including pub-
lic health emergencies, weather events, health concerns for
home visitors and client families), and other local issues.
• An assurance that virtual visits are implemented as a
model enhancement or that the Secretary has identified the
home visit as part of an effective model or model adaptation,
based on an evidence of effectiveness review.
• An assurance to the Secretary that at least one in-person
home visit shall be conducted each year, except during public
health emergencies.
Training given to home visitors providing virtual visits must be
equivalent to training for in-person visits. This provision also de-
fines certain terms used in the section and requires the Secretary
to provide technical assistance to eligible entities to ensure compli-
ance.
The section also provides a transition rule that allows virtual vis-
its that were provided before the start of fiscal year 2024, when the
law was unclear, or while entities are coming into compliance with
the new rules to be paid for using eligible entity MIECHV grants.
REASON FOR CHANGE
A strength of the MIECHV program is its reliance on home vis-
iting and meaningful in-person interactions between families and
qualified, trained home visitors. The Consolidated Appropriations
Act provided temporary flexibility for states to conduct virtual
home visits during the pandemic. Stakeholders and states have
said this flexibility was beneficial to the program and recommend
it be included as a permanent feature.
The Committee wished to extend this flexibility, clarify the law
regarding the use of virtual visits, and ensure that Congress and
the Secretary knew when and how they were being used by eligible
entities. This section allows home visiting programs to use this tool
when it is in the best interest of the family and appropriate within
the evidence-based model, but maintains MIECHV’s commitment
to in-person visits. It is our intent that virtual visits be used for
that reason. The provision specifies that virtual visiting is to be an
enhancement to MIECHV’s evidence-based models and not replace
in-person visits. It also ensures that training for home visitors on
virtual visits is rigorous and equivalent to training for in-person
visits, guarantees at least one in-person visit per year, and requires
appropriate evaluation or continuous quality improvement moni-
toring of virtual visits.
This section would allow certain visits to be conducted remotely
but with guardrails to ensure virtual visits are only used in limited
circumstances and do not replace in-person contact and home vis-
its. States would be required to provide assurances that virtual vis-
its are used as an enhancement to current models and not as a re-
placement.
EFFECTIVE DATE
Virtual Home Visiting Requirements (Section 8): Effective begin-
ning on October 1, 2023.
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25
All Other Provisions: Effective beginning on October 1, 2022.
III. VOTES OF THE COMMITTEE
In compliance with clause 3(b) of rule XIII of the Rules of the
House of Representatives, the following statement is made con-
cerning the votes of the Committee on Ways and Means in its con-
sideration of H.R. 8876, the ‘‘Jackie Walorski Maternal and Child
Home Visiting Reauthorization Act of 2022’’.
An amendment was offered by Dr. Wenstrup. The amendment
was agreed to by voice vote with a quorum being present.
An amendment in the nature of a substitute to H.R. 8876 was
agreed to by voice vote with a quorum being present.
H.R. 8876 as amended by an amendment in the nature of a sub-
stitute was ordered favorably reported to the House of Representa-
tives by a recorded vote of 41 yeas to 0 nays with a quorum being
present. The vote was as follows:
Representative Yea Nay Present Representative Yea Nay Present
Mr. Doggett ............................... X ......... ............. Mr. Brady ................................. X ......... .............
Mr. Thompson ........................... X ......... ............. Mr. Buchanan .......................... X ......... .............
Mr. Larson ................................. X ......... ............. Mr. Smith (NE) ......................... X ......... .............
Mr. Blumenauer ........................ X ......... ............. Mr. Kelly ................................... X ......... .............
Mr. Kind .................................... X ......... ............. Mr. Smith (MO) ........................ X ......... .............
Mr. Pascrell ............................... X ......... ............. Mr. Rice .................................... X ......... .............
Mr. Davis .................................. X ......... ............. Mr. Schweikert ......................... X ......... .............
Ms. Sanchez .............................. X ......... ............. Mr. LaHood ............................... X ......... .............
Mr. Higgins ............................... X ......... ............. Dr. Wenstrup ............................ X ......... .............
Ms. Sewell ................................. X ......... ............. Mr. Arrington ............................ X ......... .............
Ms. Delbene .............................. X ......... ............. Dr. Ferguson ............................. X ......... .............
Ms. Chu .................................... X ......... ............. Mr. Estes .................................. X ......... .............
Ms. Moore ................................. X ......... ............. Mr. Smucker ............................. X ......... .............
Mr. Kildee .................................. X ......... ............. Mr. Hern ................................... X ......... .............
Mr. Boyle ................................... X ......... ............. Ms. Miller ................................. X ......... .............
Mr. Beyer ................................... X ......... ............. Dr. Murphy ............................... X ......... .............
Mr. Evans .................................. X ......... ............. Mr. Kustoff ............................... X ......... .............
Mr. Schneider ............................ X
Mr. Suozzi ................................. X
Mr. Panetta ............................... X
Ms. Murphy ............................... X
Mr. Gomez ................................. X
Mr. Horsford .............................. X
Ms. Plaskett .............................. X
Chairman Neal .......................... X
Totals ............................... 25 ......... ............. Totals .............................. 16
IV. BUDGET EFFECTS OF THE BILL
A. COMMITTEE ESTIMATE OF BUDGETARY EFFECTS
In compliance with clause 3(d) of rule XIII of the Rules of the
House of Representatives, the following statement is made con-
cerning the effects on the budget of the bill, H.R. 8876, as reported.
The Committee agrees with the estimate prepared by the Congres-
sional Budget Office (CBO), which is included below.
B. STATEMENT REGARDING NEW BUDGET AUTHORITY AND TAX
EXPENDITURES BUDGET AUTHORITY
In compliance with clause 3(c)(2) of rule XIII of the Rules of the
House of Representatives, the Committee states that the bill pro-
vides new budget authority, as described in the included estimate
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26
from the Congressional Budget Office. The Committee states fur-
ther that the bill involves no new or increased tax expenditures.
C. COST ESTIMATE PREPARED BY THE CONGRESSIONAL
BUDGET OFFICE
In compliance with clause 3(c)(3) of rule XIII of the Rules of the
House of Representatives, requiring a cost estimate prepared by
the CBO, the following statement by CBO is provided.
U.S. CONGRESS,
CONGRESSIONAL BUDGET OFFICE,
Washington, DC, October 11, 2022.
Hon. RICHARD NEAL,
Chairman, Committee on Ways and Means,
House of Representatives, Washington, DC.
DEAR MR. CHAIRMAN: The Congressional Budget Office has pre-
pared the enclosed cost estimate for H.R. 8876, the Jackie Walorski
Maternal and Child Home Visiting Reauthorization Act of 2022.
If you wish further details on this estimate, we will be pleased
to provide them. The CBO staff contact is Carolyn Ugolino.
Sincerely,
PHILLIP L. SWAGEL,
Director.
Enclosure.
H.R. 8876 would reauthorize the Maternal, Infant, and Early
Childhood Home Visiting (MIECHV) program through fiscal year
2027 and appropriate funds for the program for each fiscal year
from 2023 through 2027. CBO estimates that enacting the bill
would cost about $3 billion over the 2023–2032 period.
The Health Resources and Services Administration manages the
MIECHV grant program. Program funding is distributed to states,
territories, and tribal entities to develop and implement evidence-
based, voluntary programs that aim to improve maternal and child
health, prevent child abuse and neglect, encourage positive par-
Insert offset folio 32 here HR559.001
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27
enting, and promote child development and school readiness. In fis-
cal year 2022, the MIECHV program received $400 million.
H.R. 8876 would appropriate $500 million for each fiscal year
2023 through 2027 for federal base grants for the program. Start-
ing in fiscal year 2024, H.R. 8876 would also appropriate funding
to make federal matching grants available subject to a rate of 75
percent federal funds and 25 percent nonfederal funds. Any unobli-
gated federal matching funds in a fiscal year would be redistrib-
uted to eligible entities subject to their capacity to provide the re-
quired match.
The costs of the legislation, detailed in Table 1, fall within budg-
et function 550 (health).
TABLE 1.—ESTIMATED BUDGETARY EFFECTS OF H.R. 8876
By fiscal year, millions of dollars—
2023– 2023–
2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2027 2032
Increases in Direct Spending
Budget Authority ........................................ 500 550 600 650 800 0 0 0 0 0 3,100 3,100
Estimated Outlays ..................................... 15 175 380 519 554 597 485 255 90 0 1,643 3,070
The Statutory Pay-As-You-Go Act of 2010 establishes budget-re-
porting and enforcement procedures for legislation affecting direct
spending or revenues. The net changes in outlays that are subject
to those pay-as-you-go procedures are shown in Table 2.
TABLE 2.—CBO’S ESTIMATE OF THE STATUTORY PAY-AS-YOU-GO EFFECTS OF H.R. 8876, THE
JACKIE WALORSKI MATERNAL AND CHILD HOME VISITING REAUTHORIZATION ACT OF 2022, AS
ORDERED REPORTED BY THE HOUSE COMMITTEE ON WAYS AND MEANS ON SEPTEMBER 21,
2022
By fiscal year, millions of dollars—
2023– 2023–
2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2027 2032
Net Increase in Deficit
Pay-As-You-Go Effect ................................ 15 175 380 519 554 597 485 255 90 0 1,643 3,070
Estimate Prepared By: Federal Costs: Carolyn Ugolino; Man-
dates: Andrew Laughlin.
Estimate Reviewed By: Leo Lex, Deputy Director for Budget
Analysis.
V. OTHER MATTERS TO BE DISCUSSED UNDER THE
RULES OF THE HOUSE
A. COMMITTEE OVERSIGHT FINDINGS AND RECOMMENDATIONS
With respect to clause 3(c)(1) of rule XIII and clause 2(b)(1) of
rule X of the Rules of the House of Representatives, the Committee
made findings and recommendations that are reflected in this re-
port.
B. STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES
With respect to clause 3(c)(4) of rule XIII of the Rules of the
House of Representatives, the report describes performance goals
and objectives for the which the measure authorizes funding.
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28
C. INFORMATION RELATING TO UNFUNDED MANDATES
This information is provided in accordance with section 423 of
the Unfunded Mandates Reform Act of 1995 (Pub. L. No. 104–4).
The Committee has determined that the bill does not contain
Federal mandates on the private sector. The Committee has deter-
mined that the bill does not impose a Federal intergovernmental
mandate on State, local, or tribal governments.
D. ADVISORY COMMITTEE STATEMENT
No advisory committees within the meaning of section 5(b) of the
Federal Advisory Committee Act were created by the bill.
E. APPLICABILITY TO LEGISLATIVE BRANCH
The Committee finds that the bill does not relate to the terms
and conditions of employment or access to public services or accom-
modations within the meaning of section 102(b)(2) of the Congres-
sional Accountability Act.
F. CONGRESSIONAL EARMARKS, LIMITED TAX BENEFITS, AND
LIMITED TARIFF BENEFITS
With respect to clause 9 of rule XXI of the Rules of the House
of Representatives, the Committee has carefully reviewed the pro-
visions of the bill, and states that the provisions of the bill do not
contain any congressional earmarks, limited tax benefits, or limited
tariff benefits within the meaning of the rule.
G. DUPLICATION OF FEDERAL PROGRAMS
In compliance with clause 3(c)(5) of rule XIII of the Rules of the
House of Representatives, the Committee states that no provision
of the bill establishes or reauthorizes: (1) a program of the Federal
Government known to be duplicative of another Federal program;
(2) a program included in any report to Congress pursuant to sec-
tion 21 of Public Law 111–139; or (3) a program related to a pro-
gram identified in the most recent Catalog of Federal Domestic As-
sistance, published pursuant section 6104 of title 31, United States
Code.
H. HEARINGS
Pursuant to clause 3(c)(6) of rule VIII, clause 12 of rule XXI, and
sec. 3(u) of H. Res. 8 (117th Congress), the following hearing was
used to develop or consider H.R. 8876: ‘‘Improving Family Out-
comes through Home Visiting,’’ held on March 16, 2022, and de-
scribed in the legislative history section.
VI. CHANGES IN EXISTING LAW MADE BY THE BILL
A. TEXT OF EXISTING LAW AMENDED OR REPEALED BY THE BILL
Pursuant to clause 3(e) of rule XIII of the Rules of the House of
Representatives, the text of changes in existing law made by the
bill, as reported, are shown below.
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29
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 omit-
ted is enclosed in black brackets, new matter is printed in italics,
and existing law in which no change is proposed is shown in
roman):
SOCIAL SECURITY ACT
* * * * * * *
TITLE V—MATERNAL AND CHILD HEALTH SERVICES
BLOCK GRANT
* * * * * * *
SEC. 511. MATERNAL, INFANT, AND EARLY CHILDHOOD HOME VIS-
ITING PROGRAMS.
(a) PURPOSES.—The purposes of this section are—
(1) to strengthen and improve the programs and activities
carried out under this title;
(2) to improve coordination of services for at risk commu-
nities; and
(3) to identify and provide comprehensive services to improve
outcomes for families who reside in at risk communities.
(b) REQUIREMENT FOR ALL STATES TO ASSESS STATEWIDE NEEDS
AND IDENTIFY AT RISK COMMUNITIES.—
(1) IN GENERAL.—Each State shall, as a condition of receiv-
ing payments from an allotment for the State under section
502, conduct a statewide needs assessment (which may be sep-
arate from but in coordination with the statewide needs assess-
ment required under section 505(a) and which shall be re-
viewed and updated by the State not later than October 1,
2020) that identifies—
(A) communities with concentrations of—
(i) premature birth, low-birth weight infants, and in-
fant mortality, including infant death due to neglect,
or other indicators of at-risk prenatal, maternal, new-
born, or child health;
(ii) poverty;
(iii) crime;
(iv) domestic violence;
(v) high rates of high-school drop-outs;
(vi) substance abuse;
(vii) unemployment; or
(viii) child maltreatment;
(B) the quality and capacity of existing programs or ini-
tiatives for early childhood home visitation in the State in-
cluding—
(i) the number and types of individuals and families
who are receiving services under such programs or ini-
tiatives;
(ii) the gaps in early childhood home visitation in
the State; and
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(iii) the extent to which such programs or initiatives
are meeting the needs of eligible families described in
subsection ø(k)(2)¿ (l)(2); and
(C) the State’s capacity for providing substance abuse
treatment and counseling services to individuals and fami-
lies in need of such treatment or services.
(2) COORDINATION WITH OTHER ASSESSMENTS.—In conducting
the statewide needs assessment required under paragraph (1),
the State shall coordinate with, and take into account, other
appropriate needs assessments conducted by the State, as de-
termined by the Secretary, including the needs assessment re-
quired under section 505(a) (both the most recently completed
assessment and any such assessment in progress), the com-
munitywide strategic planning and needs assessments con-
ducted in accordance with section 640(g)(1)(C) of the Head
Start Act, and the inventory of current unmet needs and cur-
rent community-based and prevention-focused programs and
activities to prevent child abuse and neglect, and other family
resource services operating in the State required under section
205(3) of the Child Abuse Prevention and Treatment Act.
(3) SUBMISSION TO THE SECRETARY.—Each State shall submit
to the Secretary, in such form and manner as the Secretary
shall require—
(A) the results of the statewide needs assessment re-
quired under paragraph (1); and
(B) a description of how the State intends to address
needs identified by the assessment, particularly with re-
spect to communities identified under paragraph (1)(A),
which may include applying for a grant to conduct an early
childhood home visitation program in accordance with the
requirements of this section.
(c) GRANTS FOR EARLY CHILDHOOD HOME VISITATION PRO-
GRAMS.—
(1) AUTHORITY TO MAKE GRANTS.—In addition to any other
payments made under this title to a State, the Secretary shall
make grants to eligible entities to enable the entities to deliver
services under early childhood home visitation programs that
satisfy the requirements of subsection (d) to eligible families in
order to promote improvements in maternal and prenatal
health, infant health, child health and development, parenting
related to child development outcomes, school readiness, and
the socioeconomic status of such families, and reductions in
child abuse, neglect, and injuries.
(2) AUTHORITY TO USE INITIAL GRANT FUNDS FOR PLANNING
OR IMPLEMENTATION.—An eligible entity that receives a grant
under paragraph (1) may use a portion of the funds made
available to the entity during the first 6 months of the period
for which the grant is made for planning or implementation ac-
tivities to assist with the establishment of early childhood
home visitation programs that satisfy the requirements of sub-
section (d).
(3) AUTHORITY TO USE GRANT FOR A PAY FOR OUTCOMES INI-
TIATIVE.—An eligible entity to which a grant is made under
paragraph (1) may use up to 25 percent of the grant for out-
comes or success payments related to a pay for outcomes initia-
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31
tive that will not result in a reduction of funding for services
delivered by the entity under a childhood home visitation pro-
gram under this section while the eligible entity develops or
operates such an initiative.
ø(4) GRANT DURATION.—The Secretary shall determine the
period of years for which a grant is made to an eligible entity
under paragraph (1).¿
(4) GRANT AMOUNTS.—
(A) BASE GRANTS.—
(i) IN GENERAL.—
(I) GENERAL RULE.—With respect to each of fis-
cal years 2023 through 2027 for which an eligible
entity not referred to in subsection (k)(2)(A) is
awarded a base grant under this section, the
amount of the grant payable to the eligible entity
for the fiscal year is the amount described by
clause (ii) of this subparagraph with respect to the
eligible entity, except as provided in subclause (II)
of this clause.
(II) SUBSTITUTION OF SUCCESSOR ELIGIBLE ENTI-
TY FOR PREDECESSOR.—If the 1st fiscal year for
which an eligible entity is awarded a base grant
under this section for a program operated in a
State is among fiscal years 2024 through 2027, the
amount described by clause (ii) with respect to the
eligible entity is the amount of the base grant for
which a program operated in the State was eligible
under this subparagraph for fiscal year 2023.
(ii) AMOUNT DESCRIBED.—
(I) GENERAL RULE.—Subject to the succeeding
provisions of this clause, the amount described by
this clause with respect to an eligible entity is—
(aa) the amount made available under sub-
section (k) for base grants for fiscal year 2023
that remains after making the reservations re-
quired by subsection (k)(2) or any other reduc-
tions required by Federal law for fiscal year
2023; multiplied by
(bb) the percentage of children in all States
who have not attained 5 years of age (as deter-
mined by the Secretary on the basis of the
data most recently available before fiscal year
2023) that is represented by the number of
such children in the State in which the eligible
entity is operating a program pursuant to this
section (as so determined).
(II) ADJUSTMENTS TO ENSURE STABLE FUND-
ING.—If the amount otherwise payable to an eligi-
ble entity under subclause (I) for fiscal year 2023
is less than 90 percent, or greater than 110 per-
cent, of the amount payable under this section to
the eligible entity for the program for fiscal year
2021, the Secretary shall increase the amount oth-
erwise so payable to 90 percent, or decrease the
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32
amount otherwise so payable to 110 percent, as the
case may be, of the amount otherwise so payable.
(III) ADJUSTMENT TO ENSURE ALL BASE GRANT
FUNDS ARE ALLOCATED.—If the amount described
by subclause (I)(aa) is different than the total of
the amounts otherwise described by subclause (I)
after applying subclause (II), the Secretary shall
increase or decrease the amounts otherwise so de-
scribed after applying subclause (II) by such equal
percentage as is necessary to reduce that difference
to zero.
(IV) MINIMUM BASE GRANT AMOUNT.—Notwith-
standing the preceding provisions of this clause,
the amount described by this clause with respect to
an eligible entity shall be not less than $1,000,000.
(B) MATCHING GRANTS.—
(i) AMOUNT OF GRANT.—
(I) GENERAL RULE.—With respect to each of fis-
cal years 2024 through 2027 for which an eligible
entity not referred to in subsection (k)(2)(A) is
awarded a grant under this section, the Secretary
shall increase the amount of the grant payable to
the eligible entity for the fiscal year under sub-
paragraph (A) of this paragraph by the matching
amount (if any) determined under subclause (II) of
this clause with respect to the eligible entity for the
fiscal year and the additional matching amount (if
any) determined under clause (iii) of this subpara-
graph with respect to the eligible entity for the fis-
cal year.
(II) MATCHING AMOUNT.—
(aa) IN GENERAL.—Subject to item (bb) of
this subclause, the matching amount with re-
spect to an eligible entity for a fiscal year is 75
percent of the sum of—
(AA) the total amount obligated by the
eligible entity for home visiting services in
the State for the fiscal year, from Federal
funds made available for the fiscal year
under this subparagraph; and
(BB) the total amount so obligated by
the eligible entity from non-Federal funds,
determined under subclause (III).
(bb) LIMITATION.—The matching amount
with respect to an eligible entity for a fiscal
year shall not exceed the allotment under sub-
clause (IV) for the State in which the eligible
entity is operating a program under this sec-
tion for the fiscal year.
(III) DETERMINATION OF OBLIGATIONS FROM
NON-FEDERAL FUNDS.—For purposes of this clause,
the total amount obligated by an eligible entity
from non-Federal funds is the total of the amounts
that are obligated by the eligible entity from non-
Federal sources, to the extent that—
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33
(aa) the services are delivered in compliance
with subsections (d)(2) and (d)(3);
(bb) the eligible entity has reported the obli-
gations to the Secretary; and
(cc) the amount is not counted toward meet-
ing the maintenance of effort requirement in
subsection (f).
(IV) STATE ALLOTMENTS.—The amount allotted
under this subclause for a State in which an eligi-
ble entity is operating a program under this sec-
tion for a fiscal year is—
(aa) the minimum matching grant alloca-
tion amount for the fiscal year; plus
(bb)(AA) the amount (if any) by which the
amount made available under subsection (k)
for matching grants for the fiscal year that re-
mains after making the reservations required
by subsection (k)(2) or any other reduction re-
quired by Federal law for the fiscal year ex-
ceeds the sum of the minimum matching grant
allocation amounts for all eligible entities for
the fiscal year; multiplied by
(BB) the percentage of children in all States
who have not attained 5 years of age and are
members of families with income not exceeding
the poverty line (as determined by the Sec-
retary on the basis of the most recently avail-
able data) that is represented by the number of
such children in the State (as so determined).
(V) MINIMUM MATCHING GRANT ALLOCATION
AMOUNT.—Subject to subclause (VI), for purposes
of subclause (IV), the minimum matching grant al-
location amount for a fiscal year is—
(aa) in the case of fiscal year 2024,
$776,000;
(bb) in the case of fiscal year 2025,
$1,000,000;
(cc) in the case of fiscal year 2026,
$1,500,000; and
(dd) in the case of fiscal year 2027,
$2,000,000.
(VI) SPECIAL RULE.—If, after making any reduc-
tions otherwise required by law for a fiscal year,
the amount made available for matching grants
under this clause for the fiscal year is insufficient
to provide the minimum matching grant allocation
amount to each eligible entity operating a program
under this section for the fiscal year, the Secretary
may make a proportionate adjustment to the min-
imum matching grant allocation amount for the
fiscal year to accommodate the reductions.
(ii) SUBMISSION OF STATEMENT EXPRESSING INTER-
EST IN ADDITIONAL MATCHING FUNDS IF AVAILABLE.—
Before the beginning of a fiscal year for which an eligi-
ble entity desires a matching grant under this subpara-
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34
graph for a program operated under this section, the
eligible entity shall submit to the Secretary a statement
as to whether the eligible entity desires additional
matching grant funds that may be made available
under clause (iii) for the fiscal year.
(iii) CARRYOVER AND REALLOCATION OF UNOBLIGATED
FUNDS.—
(I) IN GENERAL.—If the Secretary determines
that an amount allotted under clause (i)(IV) of this
subparagraph for a fiscal year will not be awarded
during the fiscal year, or that an amount made
available under subsection (k)(1) for a fiscal year
for matching grants will not be obligated by an eli-
gible entity for the fiscal year, the amount shall be
available for matching grants under this subpara-
graph for the succeeding fiscal year for eligible en-
tities that have made submissions under clause (ii)
of this subparagraph for additional matching
grant funds from the amount.
(II) STATE ALLOTMENTS.—The Secretary shall
allot to each eligible entity that has made such a
submission for a fiscal year—
(aa) the total amount (if any) made avail-
able under subclause (I) for the fiscal year;
multiplied by
(bb) the percentage of children who have not
attained 5 years of age and are members of
families with income not exceeding the poverty
line (as determined by the Secretary on the
basis of the most recently available data) in
all of the States in which any eligible entity
that has made such a submission is so oper-
ating a program, that is represented by the
number of such children in the State (as so de-
termined) in which the eligible entity is oper-
ating such a program.
(III) ADDITIONAL MATCHING AMOUNT.—
(aa) IN GENERAL.—Subject to item (bb) of
this subclause, the additional matching
amount with respect to an eligible entity for a
fiscal year is 75 percent of the sum of—
(AA) the total amount obligated by the
eligible entity for home visiting services in
the State for the fiscal year, from Federal
funds made available for the fiscal year
under this subparagraph; and
(BB) the total amount so obligated by
the eligible entity from non-Federal funds,
determined under clause (i)(III),
that are not taken into account in determining
the matching amount with respect to the eligi-
ble entity under clause (i).
(bb) LIMITATION.—The additional matching
amount with respect to an eligible entity for a
fiscal year shall not exceed the allotment
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35
under subclause (II) for the State in which the
eligible entity is operating a program under
this section for the fiscal year.
(5) TECHNICAL ASSISTANCE.—The Secretary shall provide an
eligible entity that receives a grant under paragraph (1) with
technical assistance in administering programs or activities
conducted in whole or in part with grant funds.
(d) REQUIREMENTS.—The requirements of this subsection for an
early childhood home visitation program conducted with a grant
made under this section are as follows:
(1) QUANTIFIABLE, MEASURABLE IMPROVEMENT IN øBENCH-
MARK AREAS¿ BENCHMARK AREAS RELATED TO INDIVIDUAL FAM-
ILY OUTCOMES.—
(A) IN GENERAL.—The eligible entity establishes, subject
to the approval of the Secretary, quantifiable, measurable
3- and 5-year benchmarks for demonstrating that the pro-
gram results in improvements for the eligible families par-
ticipating in the program in the following areas:
(i) Improved maternal and newborn health.
(ii) Prevention of child injuries, child abuse, neglect,
or maltreatment, and reduction of emergency depart-
ment visits.
(iii) Improvement in school readiness and achieve-
ment.
(iv) Reduction in crime or domestic violence.
(v) Improvements in family economic self-sufficiency.
(vi) Improvements in the coordination and referrals
for other community resources and supports.
(B) OUTCOMES DASHBOARDS.—The Secretary shall, di-
rectly or by grant or contract, establish and operate a
website accessible to the public that includes an annually
updated dashboard that—
(i) provides easy-to-understand information on the
outcomes achieved by each eligible entity with respect
to each of the benchmarks described in subparagraph
(A) of this paragraph that apply to the eligible entity,
which shall be based on only the data elements or types
of data collected before the date of the enactment of this
section unless administering agencies and the Sec-
retary agree pursuant to subsection (h)(6) that addi-
tional data is required;
(ii) includes a template provided by the Secretary
that will enable comparison among eligible entities not
referred to in subsection (k)(2)(A) of—
(I) a profile of each eligible entity showing out-
come indicators and how the outcomes compare to
benchmarks described in subclause (II);
(II) information on the outcome indicators and
requisite outcome levels established for each eligi-
ble entity;
(III) information on each model employed in the
program operated by each eligible entity, and re-
garding each benchmark area described in sub-
section (d)(1)(A) in which the model used by the el-
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36
igible entity is expected to affect participant out-
comes;
(IV) the most recently available information
from the report required by subparagraph (E) of
this paragraph;
(V) an electronic link to the State needs assess-
ment under subsection (b)(1); and
(VI) information regarding any penalty imposed,
or other corrective action taken, by the Secretary
against a State for failing to achieve a requisite
outcome level or any other requirement imposed by
or under this section, and an indication as to
whether the eligible entity is operating under a cor-
rective action plan under subparagraph (E)(ii) of
this paragraph, and if so, a link to the plan, an ex-
planation of the reason for the implementation of
the plan, and a report on any progress made in op-
erating under the plan;
(iii) includes information relating to those eligible
entities for which funding is reserved under subsection
(k)(2)(A), with modifications as necessary to reflect trib-
al sovereignty, data privacy, and participant confiden-
tiality; and
(iv) protects data privacy and confidentiality of par-
ticipant families.
ø(B)¿ (C) DEMONSTRATION OF IMPROVEMENTS AFTER 3
YEARS.—
(i) REPORT TO THE SECRETARY.—Not later than 30
days after the end of the 3rd year in which the eligible
entity conducts the program, the entity submits to the
Secretary a report demonstrating improvement in at
least 4 of the areas specified in subparagraph (A).
(ii) CORRECTIVE ACTION PLAN.—If the report sub-
mitted by the eligible entity under clause (i) fails to
demonstrate improvement in at least 4 of the areas
specified in subparagraph (A), the entity shall develop
and implement a plan to improve outcomes in each of
the areas specified in subparagraph (A), subject to ap-
proval by the Secretary. The plan shall include provi-
sions for the Secretary to monitor implementation of
the plan and conduct continued oversight of the pro-
gram, including through submission by the entity of
regular reports to the Secretary.
(iii) TECHNICAL ASSISTANCE.—
(I) IN GENERAL.—The Secretary shall provide an
eligible entity required to develop and implement
an improvement plan under clause (ii) with tech-
nical assistance to develop and implement the
plan. The Secretary may provide the technical as-
sistance directly or through grants, contracts, or
cooperative agreements.
(II) ADVISORY PANEL.—The Secretary shall es-
tablish an advisory panel for purposes of obtaining
recommendations regarding the technical assist-
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37
ance provided to entities in accordance with sub-
clause (I).
(iv) NO IMPROVEMENT OR FAILURE TO SUBMIT RE-
PORT.—If the Secretary determines after a period of
time specified by the Secretary that an eligible entity
implementing an improvement plan under clause (ii)
has failed to demonstrate any improvement in the
areas specified in subparagraph (A), or if the Secretary
determines that an eligible entity has failed to submit
the report required under clause (i), the Secretary
shall terminate the entity’s grant and may include any
unexpended grant funds in grants made to nonprofit
organizations under subsection (h)(2)(B).
ø(C)¿ (D) FINAL REPORT.—Not later than December 31,
2015, the eligible entity shall submit a report to the Sec-
retary demonstrating improvements (if any) in each of the
areas specified in subparagraph (A).
ø(D)¿ (E) DEMONSTRATION OF IMPROVEMENTS IN SUBSE-
QUENT YEARS.—
(i) CONTINUED MEASUREMENT OF IMPROVEMENT IN
APPLICABLE BENCHMARK AREAS.—The eligible entity,
after demonstrating improvements for eligible families
as specified in subparagraphs (A) and ø(B)¿ (C), shall
continue to track and report, not later than 30 days
after the end of fiscal year 2020 and every 3 years
thereafter, information demonstrating that the pro-
gram results in improvements for the eligible families
participating in the program in at least 4 of the areas
specified in subparagraph (A) that the service delivery
model or models selected by the entity are intended to
improve.
(ii) CORRECTIVE ACTION PLAN.—If the eligible entity
fails to demonstrate improvement in at least 4 of the
areas specified in subparagraph (A), as compared to el-
igible families who do not receive services under an
early childhood home visitation program, the entity
shall develop and implement a plan to improve out-
comes in each of the areas specified in subparagraph
(A) that the service delivery model or models selected
by the entity are intended to improve, subject to ap-
proval by the Secretary. The plan shall include provi-
sions for the Secretary to monitor implementation of
the plan and conduct continued oversight of the pro-
gram, including through submission by the entity of
regular reports to the Secretary.
(iii) TECHNICAL ASSISTANCE.—The Secretary shall
provide an eligible entity required to develop and im-
plement an improvement plan under clause (ii) with
technical assistance to develop and implement the
plan. The Secretary may provide the technical assist-
ance directly or through grants, contracts, or coopera-
tive agreements.
(iv) NO IMPROVEMENT OR FAILURE TO SUBMIT RE-
PORT.—If the Secretary determines after a period of
time specified by the Secretary that an eligible entity
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38
implementing an improvement plan under clause (ii)
has failed to demonstrate any improvement in at least
4 of the areas specified in subparagraph (A), or if the
Secretary determines that an eligible entity has failed
to submit the report required by clause (i), the Sec-
retary shall terminate the grant made to the entity
under this section and may include any unexpended
grant funds in grants made to nonprofit organizations
under subsection (h)(2)(B).
(2) IMPROVEMENTS IN OUTCOMES FOR INDIVIDUAL FAMILIES.—
(A) IN GENERAL.—The program is designed, with respect
to an eligible family participating in the program, to result
in the participant outcomes described in subparagraph (B)
that the eligible entity identifies on the basis of an individ-
ualized assessment of the family, are relevant for that
family.
(B) PARTICIPANT OUTCOMES.—The participant outcomes
described in this subparagraph are the following:
(i) Improvements in prenatal, maternal, and new-
born health, including improved pregnancy outcomes
(ii) Improvements in child health and development,
including the prevention of child injuries and mal-
treatment and improvements in cognitive, language,
social-emotional, and physical developmental indica-
tors.
(iii) Improvements in parenting skills.
(iv) Improvements in school readiness and child aca-
demic achievement.
(v) Reductions in crime or domestic violence.
(vi) Improvements in family economic self-suffi-
ciency.
(vii) Improvements in the coordination of referrals
for, and the provision of, other community resources
and supports for eligible families, consistent with
State child welfare agency training.
(3) CORE COMPONENTS.—The program includes the following
core components:
(A) SERVICE DELIVERY MODEL OR MODELS.—
(i) IN GENERAL.—Subject to clause (ii), the program
is conducted using 1 or more of the service delivery
models described in item (aa) or (bb) of subclause (I)
or in subclause (II) selected by the eligible entity:
(I) The model conforms to a clear consistent
home visitation model that has been in existence
for at least 3 years and is research-based, ground-
ed in relevant empirically-based knowledge, linked
to program determined outcomes, associated with
a national organization or institution of higher
education that has comprehensive home visitation
program standards that ensure high quality serv-
ice delivery and continuous program quality im-
provement, and has demonstrated significant,
(and in the case of the service delivery model de-
scribed in item (aa), sustained) positive outcomes,
as described in the benchmark areas specified in
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paragraph (1)(A) and the participant outcomes de-
scribed in paragraph (2)(B), when evaluated using
well-designed and rigorous—
(aa) randomized controlled research de-
signs, and the evaluation results have been
published in a peer-reviewed journal; or
(bb) quasi-experimental research designs.
(II) The model conforms to a promising and new
approach to achieving the benchmark areas speci-
fied in paragraph (1)(A) and the participant out-
comes described in paragraph (2)(B), has been de-
veloped or identified by a national organization or
institution of higher education, and will be evalu-
ated through well-designed and rigorous process.
(ii) MAJORITY OF GRANT FUNDS USED FOR EVIDENCE-
BASED MODELS.—An eligible entity shall use not more
than 25 percent of the amount of the grant paid to the
entity for a fiscal year for purposes of conducting a
program using the service delivery model described in
clause (i)(II).
(iii) CRITERIA FOR EVIDENCE OF EFFECTIVENESS OF
MODELS.—The Secretary shall establish criteria for
evidence of effectiveness of the service delivery models
and shall ensure that the process for establishing the
criteria is transparent and provides the opportunity
for public comment.
(B) USE OF GRANT TO PROVIDE OR SUPPORT TARGETED,
INTENSIVE HOME VISITING SERVICES.—The program uses
the grant to provide or support targeted, intensive home
visiting services for the populations described in paragraph
(5).
ø(B)¿ (C) ADDITIONAL REQUIREMENTS.—
(i) The program adheres to a clear, consistent model
that satisfies the requirements of being grounded in
empirically-based knowledge related to home visiting
and linked to the benchmark areas specified in para-
graph (1)(A) and the participant outcomes described in
paragraph (2)(B) related to the purposes of the pro-
gram.
(ii) The program employs well-trained and com-
petent staff, as demonstrated by education or training,
such as nurses, social workers, educators, child devel-
opment specialists, or other well-trained and com-
petent staff, and provides ongoing and specific training
on the model being delivered.
(iii) The program maintains high quality supervision
to establish home visitor competencies.
(iv) The program demonstrates strong organizational
capacity to implement the activities involved.
(v) The program establishes appropriate linkages
and referral networks to other community resources
and supports for eligible families.
(vi) The program monitors the fidelity of program
implementation to ensure that services are delivered
pursuant to the specified model.
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(vii) If the application submitted by the eligible entity
includes the assurance described in subsection
(e)(10)(C) with respect to the program, the program
provides in-person service consistent with the assur-
ances.
(4) VIRTUAL HOME VISITS.—
(A) IN GENERAL.—A virtual home visit conducted under
the program shall be considered a home visit for purposes
of this section if the application for funding of the program
submitted pursuant to this section most recently after the
effective date of this paragraph includes the material de-
scribed in subsection (e)(10).
(B) STANDARDS FOR TRAINING APPLICABLE TO VIRTUAL
SERVICE DELIVERY.—The standards for training require-
ments applicable to virtual service delivery under a home
visiting model shall be equivalent to those that apply to in-
person service delivery under the model.
(C) REPORTING REQUIREMENT.—A grant made under this
section for the program may not be used for any virtual
home visit during a year, unless the eligible entity to which
the grant is made submits the report described in sub-
section (e)(8)(A) for the year.
(D) VIRTUAL HOME VISIT DEFINED.—In this section, the
term ‘‘virtual home visit’’ means a visit conducted solely by
use of electronic information and telecommunications tech-
nologies.
(E) TECHNICAL ASSISTANCE.—If the Secretary finds that
an eligible entity has not complied with the assurance de-
scribed in subsection (e)(10)(C), the Secretary shall, directly
or through grants, contracts, or cooperative agreements,
provide the eligible entity with such technical assistance as
is necessary to assist the eligible entity in doing so.
ø(4)¿ (5) PRIORITY FOR SERVING HIGH-RISK POPULATIONS.—
The eligible entity gives priority to providing services under
the program to the following:
(A) Eligible families who reside in communities in need
of such services, as identified in the statewide needs as-
sessment required under subsection (b)(1)(A), taking into
account the staffing, community resource, and other re-
quirements to operate at least one approved model of home
visiting and demonstrate improvements for eligible fami-
lies.
(B) Low-income eligible families.
(C) Eligible families who are pregnant women who have
not attained age 21.
(D) Eligible families that have a history of child abuse
or neglect or have had interactions with child welfare serv-
ices.
(E) Eligible families that have a history of substance
abuse or need substance abuse treatment.
(F) Eligible families that have users of tobacco products
in the home.
(G) Eligible families that are or have children with low
student achievement.
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(H) Eligible families with children with developmental
delays or disabilities.
(I) Eligible families who, or that include individuals who,
are serving or formerly served in the Armed Forces, in-
cluding such families that have members of the Armed
Forces who have had multiple deployments outside of the
United States.
(6) LIMITATION ON USE OF FUNDS FOR ADMINISTRATIVE
COSTS.—
(A) IN GENERAL.—Except as provided in subparagraph
(B) of this paragraph, an eligible entity to which funds are
provided under subsection (c) or (h)(2)(B) shall not use
more than 10 percent of the funds to cover the costs of ad-
ministration.
(B) AUTHORITY TO GRANT EXCEPTIONS.—
(i) IN GENERAL.—The Secretary may authorize an eli-
gible entity that meets a condition of clause (ii) of this
subparagraph to exceed the percentage limitation in
subparagraph (A) with respect to a program conducted
under this subsection by not more than 5 percentage
points, subject to such terms and conditions as the Sec-
retary deems appropriate.
(ii) CONDITIONS.—An eligible entity meets a condi-
tion of this clause if the eligible entity—
(I) conducts the program by directly providing
home visits to eligible families and without a sub-
recipient;
(II) in the fiscal year for which the grant for the
program is made under this section, proposes to
expand services in 1 or more communities identi-
fied in the statewide needs assessment under sub-
section (b) and in which home visiting services are
not provided; or
(III) has conducted the program for fewer than
3 years.
(e) APPLICATION REQUIREMENTS.—An eligible entity desiring a
grant under this section shall submit an application to the Sec-
retary for approval, in such manner as the Secretary may require,
that includes the following:
(1) A description of the populations to be served by the enti-
ty, including specific information regarding how the entity will
serve high risk populations described in subsection (d)(4).
(2) An assurance that the entity will give priority to serving
low-income eligible families and eligible families who reside in
at risk communities identified in the statewide needs assess-
ment required under subsection (b)(1)(A).
(3) The service delivery model or models described in sub-
section (d)(3)(A) that the entity will use under the program and
the basis for the selection of the model or models.
(4) A statement identifying how the selection of the popu-
lations to be served and the service delivery model or models
that the entity will use under the program for such populations
is consistent with the results of the statewide needs assess-
ment conducted under subsection (b).
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(5) The quantifiable, measurable benchmarks established by
the State to demonstrate that the program contributes to im-
provements in the areas specified in subsection (d)(1)(A) that
the service delivery model or models selected by the entity are
intended to improve.
(6) An assurance that the entity will obtain and submit docu-
mentation or other appropriate evidence from the organization
or entity that developed the service delivery model or models
used under the program to verify that the program is imple-
mented and services are delivered according to the model spec-
ifications.
(7) Assurances that the entity will establish procedures to
ensure that—
(A) the participation of each eligible family in the pro-
gram is voluntary; and
(B) services are provided to an eligible family in accord-
ance with the individual assessment for that family.
(8) Assurances that the entity will—
(A) submit annual reports to the Secretary regarding the
program and activities carried out under the program that
include such information and data as the Secretary shall
require, including the number of virtual home visits con-
ducted under the program in the year covered by the report,
disaggregated with respect to each home visiting model
under which the virtual home visits are conducted; and
(B) participate in, and cooperate with, data and informa-
tion collection necessary for the evaluation required under
subsection (g)(2) and other research and evaluation activi-
ties carried out under subsection (h)(3).
(9) A description of other State programs that include home
visitation services, including, if applicable to the State, other
programs carried out under this title with funds made avail-
able from allotments under section 502(c), programs funded
under title IV, title II of the Child Abuse Prevention and
Treatment Act (relating to community-based grants for the
prevention of child abuse and neglect), and section 645A of the
Head Start Act (relating to Early Head Start programs).
(10) At the option of the eligible entity—
(A) a description of any limitations or constraints on vir-
tual home visits under the program, including—
(i) a description of the plan of the eligible entity to
encourage in-person home visits; and
(ii) a description of the considerations to be used in
determining when a virtual home visit is appropriate,
including client consent, client preference, geographic
limitations, model fidelity, and hazardous conditions
including public health emergencies, weather events,
health concerns for home visitors and client families,
and other local issues;
(B) an assurance that—
(i) the virtual home visit is implemented as a model
enhancement; or
(ii) the Secretary has identified the home visit as
part of an effective model or model adaptation, based
on an evidence of effectiveness review conducted using
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the criteria established under subsection (d)(3)(A)(iii);
and
(C) an assurance to the Secretary that at least 1 in-per-
son home visit shall be conducted for each client family
under the program during the 12-month period that begins
with the entry of the client family into the program, and
during each succeeding 12-month period, except that any
such period in which a public health emergency declared
under Federal law, or under the law of the State in which
the program is conducted, is in effect shall be extended by
the length of time in which the declaration is in effect.
ø(10)¿ (11) Other information as required by the Secretary.
ø(f) MAINTENANCE OF EFFORT.—Funds provided to an eligible en-
tity receiving a grant under this section shall supplement, and not
supplant, funds from other sources for early childhood home visita-
tion programs or initiatives.¿
(f) MAINTENANCE OF EFFORT.—
(1) IN GENERAL.—Notwithstanding any other provision of this
section, the Secretary may not make a grant to an eligible entity
under this section for a fiscal year if the total amount of non-
Federal funds obligated by the eligible entity in the State in the
fiscal year for a program operated pursuant to this section is
less than the total amount of non-Federal funds reported to
have been expended by any eligible entity for such a program
in the State in fiscal year 2019 or 2021, whichever is the lesser.
(2) PUBLICATION OF AMOUNTS.—Not later than June 30, 2023,
the Secretary shall cause to have published in the Federal Reg-
ister the amount of non-Federal funds expended as described in
this section that has been reported by each eligible entity not re-
ferred to in subsection (k)(2)(A) for each of fiscal years 2019 and
2021.
(3) GRACE PERIOD.—The Secretary may, in exceptional cir-
cumstances, allow an eligible entity a period to come into com-
pliance with this subsection. The Secretary shall provide tech-
nical assistance to any eligible entity to assist the entity in
doing so.
(g) EVALUATION.—
(1) INDEPENDENT, EXPERT ADVISORY PANEL.—The Secretary,
in accordance with subsection (h)(1)(A), shall appoint an inde-
pendent advisory panel consisting of experts in program eval-
uation and research, education, and early childhood develop-
ment—
(A) to review, and make recommendations on, the design
and plan for the evaluation required under paragraph (2)
within 1 year after the date of enactment of this section;
(B) to maintain and advise the Secretary regarding the
progress of the evaluation; and
(C) to comment, if the panel so desires, on the report
submitted under paragraph (3).
(2) AUTHORITY TO CONDUCT EVALUATION.—On the basis of
the recommendations of the advisory panel under paragraph
(1), the Secretary shall, by grant, contract, or interagency
agreement, conduct an evaluation of the statewide needs as-
sessments submitted under subsection (b) and the grants made
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under subsections (c) and (h)(3)(B). The evaluation shall in-
clude—
(A) an analysis, on a State-by-State basis, of the results
of such assessments, including indicators of maternal and
prenatal health and infant health and mortality, and State
actions in response to the assessments; and
(B) an assessment of—
(i) the effect of early childhood home visitation pro-
grams on child and parent outcomes, including with
respect to each of the benchmark areas specified in
subsection (d)(1)(A) and the participant outcomes de-
scribed in subsection (d)(2)(B);
(ii) the effectiveness of such programs on different
populations, including the extent to which the ability
of programs to improve participant outcomes varies
across programs and populations; and
(iii) the potential for the activities conducted under
such programs, if scaled broadly, to improve health
care practices, eliminate health disparities, and im-
prove health care system quality, efficiencies, and re-
duce costs.
(3) REPORT.—Not later than March 31, 2015, the Secretary
shall submit a report to Congress on the results of the evalua-
tion conducted under paragraph (2) and shall make the report
publicly available.
(h) OTHER PROVISIONS.—
(1) INTRA-AGENCY COLLABORATION.—The Secretary shall en-
sure that the Maternal and Child Health Bureau and the Ad-
ministration for Children and Families collaborate with respect
to carrying out this section, including with respect to—
(A) reviewing and analyzing the statewide needs assess-
ments required under subsection (b), the awarding and
oversight of grants awarded under this section, the estab-
lishment of the advisory panels required under subsections
(d)(1)(B)(iii)(II) and (g)(1), and the evaluation and report
required under subsection (g); and
(B) consulting with other Federal agencies with respon-
sibility for administering or evaluating programs that
serve eligible families to coordinate and collaborate with
respect to research related to such programs and families,
including the Office of the Assistant Secretary for Plan-
ning and Evaluation of the Department of Health and
Human Services, the Centers for Disease Control and Pre-
vention, the National Institute of Child Health and
Human Development of the National Institutes of Health,
the Office of Juvenile Justice and Delinquency Prevention
of the Department of Justice, and the Institute of Edu-
cation Sciences of the Department of Education.
(2) GRANTS TO ELIGIBLE ENTITIES THAT ARE NOT STATES.—
(A) INDIAN TRIBES, TRIBAL ORGANIZATIONS, OR URBAN IN-
DIAN ORGANIZATIONS.—The Secretary shall specify require-
ments for eligible entities that are Indian Tribes (or a con-
sortium of Indian Tribes), Tribal Organizations, or Urban
Indian Organizations to apply for and conduct an early
childhood home visitation program with a grant under this
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section. Such requirements shall, to the greatest extent
practicable, be consistent with the requirements applicable
to eligible entities that are States and shall require an In-
dian Tribe (or consortium), Tribal Organization, or Urban
Indian Organization to—
(i) conduct a needs assessment similar to the assess-
ment required for all States under subsection (b); and
(ii) establish quantifiable, measurable 3- and 5-year
benchmarks consistent with subsection (d)(1)(A).
(B) NONPROFIT ORGANIZATIONS.—If, as of the beginning
of fiscal year 2012, a State has not applied or been ap-
proved for a grant under this section, the Secretary may
use amounts appropriated under paragraph (1) of sub-
section ø(j)¿ (k) that are available for expenditure under
paragraph (3) of that subsection to make a grant to an eli-
gible entity that is a nonprofit organization described in
subsection ø(k)(1)(B)¿ (l)(1)(B) to conduct an early child-
hood home visitation program in the State. The Secretary
shall specify the requirements for such an organization to
apply for and conduct the program which shall, to the
greatest extent practicable, be consistent with the require-
ments applicable to eligible entities that are States and
shall require the organization to—
(i) carry out the program based on the needs assess-
ment conducted by the State under subsection (b); and
(ii) establish quantifiable, measurable 3- and 5-year
benchmarks consistent with subsection (d)(1)(A).
(3) RESEARCH AND OTHER EVALUATION ACTIVITIES.—
(A) IN GENERAL.—The Secretary shall carry out a contin-
uous program of research and evaluation activities in
order to increase knowledge about the implementation and
effectiveness of home visiting programs, using random as-
signment designs to the maximum extent feasible. The
Secretary may carry out such activities directly, or through
grants, cooperative agreements, or contracts.
(B) REQUIREMENTS.—The Secretary shall ensure that—
(i) evaluation of a specific program or project is con-
ducted by persons or individuals not directly involved
in the operation of such program or project; and
(ii) the conduct of research and evaluation activities
includes consultation with independent researchers,
State officials, and developers and providers of home
visiting programs on topics including research design
and administrative data matching.
(4) REPORT AND RECOMMENDATION.—Not later than Decem-
ber 31, 2015, the Secretary shall submit a report to Congress
regarding the programs conducted with grants under this sec-
tion. The report required under this paragraph shall include—
(A) information regarding the extent to which eligible
entities receiving grants under this section demonstrated
improvements in the areas specified in subsection (d)(1)(A);
(B) information regarding any technical assistance pro-
vided under subsection (d)(1)(B)(iii)(I), including the type
of any such assistance provided; and
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(C) recommendations for such legislative or administra-
tive action as the Secretary determines appropriate.
(5) DATA EXCHANGE STANDARDS FOR IMPROVED INTEROPER-
ABILITY.—
(A) DESIGNATION AND USE OF DATA EXCHANGE STAND-
ARDS.—
(i) DESIGNATION.—The head of the department or
agency responsible for administering a program fund-
ed under this section shall, in consultation with an
interagency work group established by the Office of
Management and Budget and considering State gov-
ernment perspectives, designate data exchange stand-
ards for necessary categories of information that a
State agency operating the program is required to
electronically exchange with another State agency
under applicable Federal law.
(ii) DATA EXCHANGE STANDARDS MUST BE NONPROPRI-
ETARY AND INTEROPERABLE.—The data exchange
standards designated under clause (i) shall, to the ex-
tent practicable, be nonproprietary and interoperable.
(iii) OTHER REQUIREMENTS.—In designating data ex-
change standards under this paragraph, the Secretary
shall, to the extent practicable, incorporate—
(I) interoperable standards developed and main-
tained by an international voluntary consensus
standards body, as defined by the Office of Man-
agement and Budget;
(II) interoperable standards developed and
maintained by intergovernmental partnerships,
such as the National Information Exchange
Model; and
(III) interoperable standards developed and
maintained by Federal entities with authority
over contracting and financial assistance.
(B) DATA EXCHANGE STANDARDS FOR FEDERAL REPORT-
ING.—
(i) DESIGNATION.—The head of the department or
agency responsible for administering a program re-
ferred to in this section shall, in consultation with an
interagency work group established by the Office of
Management and Budget, and considering State gov-
ernment perspectives, designate data exchange stand-
ards to govern Federal reporting and exchange re-
quirements under applicable Federal law.
(ii) REQUIREMENTS.—The data exchange reporting
standards required by clause (i) shall, to the extent
practicable—
(I) incorporate a widely accepted, nonpropri-
etary, searchable, computer-readable format;
(II) be consistent with and implement applicable
accounting principles;
(III) be implemented in a manner that is cost-
effective and improves program efficiency and ef-
fectiveness; and
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47
(IV) be capable of being continually upgraded as
necessary.
(iii) INCORPORATION OF NONPROPRIETARY STAND-
ARDS.—In designating data exchange standards under
this paragraph, the Secretary shall, to the extent prac-
ticable, incorporate existing nonproprietary standards,
such as the eXtensible Mark up Language.
(iv) RULE OF CONSTRUCTION.—Nothing in this para-
graph shall be construed to require a change to exist-
ing data exchange standards for Federal reporting
about a program referred to in this section, if the head
of the department or agency responsible for admin-
istering the program finds the standards to be effec-
tive and efficient.
(6) REDUCTION OF ADMINISTRATIVE BURDEN.—
(A) IN GENERAL.—The Secretary shall reduce the burden,
on States and public and private implementing agencies at
the local level, of administering this section, by—
(i) reviewing and revising administrative data collec-
tion instruments and forms to eliminate duplication
and streamline reporting requirements for States, eligi-
ble entities referred to in subsection (k)(2)(A), and non-
profit organizations referred to in subsection (l)(1)(B),
including timelines for submitting reports;
(ii) conducting an analysis of the total number of
hours reported by administering agencies on complying
with paperwork requirements, and exploring, in con-
sultation with administering agencies, ways to reduce
the number of hours spent by at least 15 percent;
(iii) conducting a review of paperwork and data col-
lection requirements for tribal grantees, and exploring,
in consultation with tribes and tribal organizations,
ways to reduce administrative burden, respect sov-
ereignty, and acknowledge the different focus points for
tribal grantees;
(iv) collecting input from relevant State fiscal offi-
cials to align fiscal requirements and oversight for
States and eligible entities to ensure consistency with
standards and guidelines for other Federal formula
grant programs; and
(v) consulting with administering agencies and serv-
ice delivery model representatives on needed and
unneeded data elements regarding the dashboards pro-
vided for in subsection (d)(1)(B), consistent with the
data requirements of such subsection.
(B) FINDINGS ON PAPERWORK REDUCTION.—
(i) INCLUSION IN REPORT.—In the 1st report sub-
mitted pursuant to subsection (j) more than 18 months
after the date of the enactment of this Act, the Sec-
retary shall include the findings of the Secretary with
respect to the matters described in subparagraph (A).
(ii) IMPLEMENTATION.—Within 2 years after com-
plying with clause (i), the Secretary shall implement
the findings referred to in clause (i).
(i) APPLICATION OF OTHER PROVISIONS OF TITLE.—
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48
(1) IN GENERAL.—Except as provided in paragraph (2), the
other provisions of this title shall not apply to a grant made
under this section.
(2) EXCEPTIONS.—The following provisions of this title shall
apply to a grant made under this section to the same extent
and in the same manner as such provisions apply to allotments
made under section 502(c):
(A) Section 504(b)(6) (relating to prohibition on pay-
ments to excluded individuals and entities).
(B) Section 504(c) (relating to the use of funds for the
purchase of technical assistance).
ø(C) Section 504(d) (relating to a limitation on adminis-
trative expenditures).¿
ø(D)¿ (C) Section 506 (relating to reports and audits),
but only to the extent determined by the Secretary to be
appropriate for grants made under this section.
ø(E)¿ (D) Section 507 (relating to penalties for false
statements).
ø(F)¿ (E) Section 508 (relating to nondiscrimination).
ø(G)¿ (F) Section 509(a) (relating to the administration
of the grant program).
(j) ANNUAL REPORT TO CONGRESS.—By December 31, 2023, and
annually thereafter, the Secretary shall submit to the Congress a
written report on the grants made under this section for the then
preceding fiscal year, which shall include—
(1) an eligible entity-by-eligible entity summary of the out-
comes measured by the entity with respect to each benchmark
described in subsection (e)(5) that apply to the entity;
(2) information regarding any technical assistance funded
under subparagraph (B) or (C) of subsection (k)(2), including
the type of any such assistance provided;
(3) information on the demographic makeup of families
served by each such entity to the extent possible while respecting
participant confidentiality, including race, ethnicity, edu-
cational attainment at enrollment, household income, and other
demographic markers as determined by the Secretary;
(4) the information described in subsection (d)(1)(E);
(5) the estimated share of the eligible population served using
grants made under this section;
(6) a description of each service delivery model funded under
this section by the eligible entities in each State, and the share
(if any) of the grants expended on each model;
(7) a description of non-Federal expenditures by eligible enti-
ties to qualify for matching funds under subsection (c)(4);
(8) information on the uses of funds reserved under sub-
section (k)(2)(C);
(9) information relating to those eligible entities for which
funding is reserved under subsection (k)(2)(A), with modifica-
tions as necessary to reflect tribal data sovereignty, data pri-
vacy, and participant confidentiality; and
(10) a list of data elements collected from eligible entities, and
the purpose of each data element in measuring performance or
enforcing requirements under this section.
ø(j)¿ (k) APPROPRIATIONS.—
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49
(1) IN GENERAL.—Out of any funds in the Treasury not oth-
erwise appropriated, there are appropriated to the Secretary to
carry out this section—
ø(A) $100,000,000 for fiscal year 2010;
ø(B) $250,000,000 for fiscal year 2011;
ø(C) $350,000,000 for fiscal year 2012;
ø(D) $400,000,000 for fiscal year 2013;
ø(E) $400,000,000 for fiscal year 2014;
ø(F) for fiscal year 2015, $400,000,000;
ø(G) for fiscal year 2016, $400,000,000; and
ø(H) for each of fiscal years 2017 through 2022,
$400,000,000.¿
(A) for fiscal year 2023, $500,000,000 for base grants;
(B) for fiscal year 2024, $550,000,000, of which
$500,000,000 shall be for base grants and $50,000,000
shall be for matching grants;
(C) for fiscal year 2025, $600,000,000, of which
$500,000,000 shall be for base grants and $100,000,000
shall be for matching grants;
(D) for fiscal year 2026, $650,000,000, of which
$500,000,000 shall be for base grants and $150,000,000
shall be for matching grants; and
(E) for fiscal year 2027, $800,000,000, of which
$500,000,000 shall be for base grants and $300,000,000
shall be for matching grants.
(2) RESERVATIONS.—Of øthe amount¿ each amount made
available for base grants and each amount made available for
matching grants appropriated under this subsection for a fiscal
year (or portion of a fiscal year), the Secretary shall reserve—
(A) ø3¿ 6 percent of such amount for purposes of making
grants to eligible entities that are Indian Tribes (or a con-
sortium of Indian Tribes), Tribal Organizations, or Urban
Indian Organizations; øand¿
ø(B) 3 percent of such amount for purposes of carrying
out subsections (d)(1)(B)(iii), (g), and (h)(3).¿
(B) 2 percent of such amount for purposes of providing
technical assistance, directly or through grants or con-
tracts, for purposes as otherwise described in subsections
(c)(5), (d)(1)(C)(iii), (d)(1)(E)(iii), and (d)(4)(E);
(C) 2 percent of such amount for purposes of workforce
support, retention, and case management, including work-
force-related technical assistance, research and evaluation,
and program administration, directly or through grants or
contracts, of which the Secretary shall use not more than
$1,500,000 to establish and operate the Jackie Walorski
Center for Evidence-Based Case Management; and
(D) 3 percent of such amount for purposes of research
and evaluation (directly or through grants or contracts),
and for administering this section (directly, through con-
tracts, or otherwise).
(3) AVAILABILITY.—
(A) IN GENERAL.—Except as provided in subparagraph
(B), funds made available to an eligible entity under this
section for a fiscal year (or portion of a fiscal year) shall
remain available for expenditure by the eligible entity
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50
through the end of the second succeeding fiscal year after
award. Any funds that are not expended by the eligible en-
tity during the period in which the funds are available
under the preceding sentence may be used for grants to
nonprofit organizations under subsection (h)(2)(B).
(B) FUNDS FOR PAY FOR OUTCOMES INITIATIVES.—Funds
made available to an eligible entity under this section for
a fiscal year (or portion of a fiscal year) for a pay for out-
comes initiative shall remain available for expenditure by
the eligible entity for not more than 10 years after the
funds are so made available.
(4) ALLOCATION OF FUNDS.—To the extent that the grant
amount awarded under this section to an eligible entity is de-
termined on the basis of relative population or poverty consid-
erations, the Secretary shall make the determination using the
most accurate Federal data available for the eligible entity.
(5) DISPOSITION OF EXCESS FUNDS RESERVED FOR RESEARCH,
EVALUATION, AND ADMINISTRATION.—To the extent that the
amounts reserved under paragraph (2)(D) for a fiscal year are
not obligated in the fiscal year, the Secretary may use the funds
for any purpose described in this section or to offset any reduc-
tion with respect to this section that is required by Federal law.
ø(k)¿ (l) DEFINITIONS.—In this section:
(1) ELIGIBLE ENTITY.—
(A) IN GENERAL.—The term ‘‘eligible entity’’ means a
State, an Indian Tribe, Tribal Organization, or Urban In-
dian Organization, Puerto Rico, Guam, the Virgin Islands,
the Northern Mariana Islands, and American Samoa.
(B) NONPROFIT ORGANIZATIONS.—Only for purposes of
awarding grants under subsection (h)(2)(B), such term
shall include a nonprofit organization with an established
record of providing early childhood home visitation pro-
grams or initiatives in a State or several States.
(2) ELIGIBLE FAMILY.—The term ‘‘eligible family’’ means—
(A) a woman who is pregnant, and the father of the child
if the father is available; or
(B) a parent or primary caregiver of a child, including
grandparents or other relatives of the child, and foster par-
ents, who are serving as the child’s primary caregiver from
birth to kindergarten entry, and including a noncustodial
parent who has an ongoing relationship with, and at times
provides physical care for, the child.
(3) INDIAN TRIBE; TRIBAL ORGANIZATION.—The terms ‘‘Indian
Tribe’’ and ‘‘Tribal Organization’’, and ‘‘Urban Indian Organiza-
tion’’ have the meanings given such terms in section 4 of the
Indian Health Care Improvement Act.
(4) PAY FOR OUTCOMES INITIATIVE.—The term ‘‘pay for out-
comes initiative’’ means a performance-based grant, contract,
cooperative agreement, or other agreement awarded by a pub-
lic entity in which a commitment is made to pay for improved
outcomes achieved as a result of the intervention that result in
social benefit and direct cost savings or cost avoidance to the
public sector. Such an initiative shall include—
(A) a feasibility study that describes how the proposed
intervention is based on evidence of effectiveness;
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(B) a rigorous, third-party evaluation that uses experi-
mental or quasi-experimental design or other research
methodologies that allow for the strongest possible causal
inferences to determine whether the initiative has met its
proposed outcomes as a result of the intervention;
(C) an annual, publicly available report on the progress
of the initiative; and
(D) a requirement that payments are made to the recipi-
ent of a grant, contract, or cooperative agreement only
when agreed upon outcomes are achieved, except that this
requirement shall not apply with respect to payments to a
third party conducting the evaluation described in sub-
paragraph (B).
SEC. 511A. EMERGENCY ASSISTANCE TO FAMILIES THROUGH HOME
VISITING PROGRAMS.
(a) SUPPLEMENTAL APPROPRIATION.—In addition to amounts oth-
erwise appropriated, out of any money in the Treasury of the
United States not otherwise appropriated, there are appropriated
to the Secretary $150,000,000, to remain available through Sep-
tember 30, 2022, to enable eligible entities to conduct programs in
accordance with section 511 and subsection (c) of this section.
(b) ELIGIBILITY FOR FUNDS.—To be eligible to receive funds made
available by subsection (a) of this section, an entity shall—
(1) as of the date of the enactment of this section, be con-
ducting a program under section 511;
(2) ensure the modification of grants, contracts, and other
agreements, as applicable, executed under section 511 under
which the program is conducted as are necessary to provide
that, during the period that begins with the date of the enact-
ment of this section and ends with the end of the 2nd suc-
ceeding fiscal year after the funds are awarded, the entity
shall—
(A) not reduce funding for, or staffing levels of, the pro-
gram on account of reduced enrollment in the program;
and
(B) when using funds to provide emergency supplies to
eligible families receiving grant services under section 511,
ensure coordination with local diaper banks to the extent
practicable; and
(3) reaffirm that, in conducting the program, the entity will
focus on priority populations (as defined in section 511(d)(4)).
(c) USES OF FUNDS.—An entity to which funds are provided
under this section shall use the funds—
(1) to serve families with home visits or with virtual visits,
that may be conducted by the use of electronic information and
telecommunications technologies, in a service delivery model
described in section 511(d)(3)(A);
(2) to pay hazard pay or other additional staff costs associ-
ated with providing home visits or administration for programs
funded under section 511;
(3) to train home visitors employed by the entity in con-
ducting a virtual home visit and in emergency preparedness
and response planning for families served, and may include
training on how to safely conduct intimate partner violence
screenings, and training on safety and planning for families
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served to support the family outcome improvements listed in
section 511(d)(2)(B);
(4) for the acquisition by families served by programs under
section 511 of such technological means as are needed to con-
duct and support a virtual home visit;
(5) to provide emergency supplies (such as diapers and dia-
pering supplies including diaper wipes and diaper cream, nec-
essary to ensure that a child using a diaper is properly cleaned
and protected from diaper rash, formula, food, water, hand
soap and hand sanitizer) to an eligible family (as defined in
section ø511(k)(2)¿ 511(l)(2));
(6) to coordinate with and provide reimbursement for sup-
plies to diaper banks when using such entities to provide emer-
gency supplies specified in paragraph (5); or
(7) to provide prepaid grocery cards to an eligible family (as
defined in section ø511(k)(2)¿ 511(l)(2)) participating in the
maternal, infant, and early childhood home visiting program
under section 511 for the purpose of enabling the family to
meet the emergency needs of the family.
* * * * * * *
Æ
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