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[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5438 Introduced in House (IH)]

<DOC>

116th CONGRESS
  1st Session
                                H. R. 5438

 To direct the Secretary of Health and Human Services, acting through 
  the Director of the Centers for Disease Control and Prevention, to 
  award grants to develop programs to increase health care providers' 
           awareness of Valley fever, and for other purposes.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                           December 16, 2019

   Mr. Cox of California (for himself, Mr. Harder of California, Mr. 
Costa, Mr. Gallego, Mr. O'Halleran, Mrs. Kirkpatrick, Mr. Panetta, and 
Mr. Grijalva) introduced the following bill; which was referred to the 
 Committee on Energy and Commerce, and in addition to the Committee on 
   Ways and Means, for a period to be subsequently determined by the 
  Speaker, in each case for consideration of such provisions as fall 
           within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL

 
 To direct the Secretary of Health and Human Services, acting through 
  the Director of the Centers for Disease Control and Prevention, to 
  award grants to develop programs to increase health care providers' 
           awareness of Valley fever, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``End Valley Fever Now Act''.

SEC. 2. GRANTS TO DEVELOP PROGRAMS TO INCREASE HEALTH CARE PROVIDERS' 
              AWARENESS OF VALLEY FEVER.

    Part P of title III of the Public Health Service Act (42 U.S.C. 
280g et seq.) is amended by adding at the end the following:

``SEC. 399V-7. GRANTS TO DEVELOP PROGRAMS TO INCREASE HEALTH CARE 
              PROVIDERS' AWARENESS OF VALLEY FEVER.

    ``(a) In General.--The Secretary, acting through the Administrator 
of the Health Resources and Services Administration and in consultation 
with the Director of the Centers for Disease Control and Prevention, 
shall make awards of grants or cooperative agreements to eligible 
entities to establish and carry out programs--
            ``(1) to increase health care providers' awareness of 
        Valley fever; and
            ``(2) to educate and train health care providers on the 
        diagnosis and treatment of Valley fever.
    ``(b) Use of Funds.--An eligible entity selected to receive a grant 
or contract under this section shall use amounts awarded under such a 
grant or contract to provide innovative supportive activities (which 
may include activities that do not rely on the use of broadband 
services) to enhance education through distance learning, continuing 
educational activities, collaborative conferences, and electronic and 
telelearning activities.
    ``(c) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $1,000,000 for the period of 
fiscal years 2021 through 2023, to remain available until expended.
    ``(d) Condition.--A recipient of a grant under this section shall, 
as a condition on receipt of the grant, agree to develop curricula for 
the purposes specified in subsection (a) in coordination with local 
providers at hospitals and clinics.
    ``(e) Definitions.--In this section:
            ``(1) The term `eligible entity' means--
                    ``(A) a State department of health (or similar 
                State authority);
                    ``(B) an institution of higher education (as 
                defined in section 101 of the Higher Education Act of 
                1965 (20 U.S.C. 1001)), including a medical school or 
                continuing medical education program at such 
                institution;
                    ``(C) an entity operating a graduate medical 
                residency training program under section 340E or under 
                section 340H; or
                    ``(D) a teaching hospital (as defined in section 
                415.152 of title 42, Code of Federal Regulations) that 
                has physicians and other medical providers with 
                specialized knowledge in diagnosing and treating Valley 
                fever.
            ``(2) The term `Valley fever' means the condition caused by 
        Coccidioidomycosis.''.

SEC. 3. STUDY COMPARING DIFFERENT CASE DEFINITIONS USED TO IDENTIFY 
              VALLEY FEVER.

    (a) In General.--The Secretary of Health and Human Services, acting 
through the Director of the Centers for Disease Control and Prevention 
shall conduct a study comparing different case definitions used to 
identify valley fever. Such study shall include the efficacy of the 
methods being used to establish such case definitions and the cost 
effectiveness of such methods, including using the case definition for 
valley fever established by the Council of State and Territorial 
Epidemiologist.
    (b) Valley Fever Defined.--In this Act, the term ``Valley fever'' 
has the meaning given the term in section 399V-7 of the Public Health 
Service Act.

SEC. 4. ALLOWING STATES TO PROVIDE COVERAGE UNDER THE MEDICAID PROGRAM 
              FOR ITEMS AND SERVICES FURNISHED IN CONNECTION WITH 
              QUALIFYING VALLEY FEVER CLINICAL TRIALS.

    (a) In General.--Section 1905(a) of the Social Security Act (42 
U.S.C. 1396d(a)) is amended--
            (1) in paragraph (29), by striking ``and'' at the end;
            (2) by redesignating paragraph (30) as paragraph (31); and
            (3) by inserting after paragraph (29) the following new 
        paragraph:
            ``(30) items and services furnished in connection with 
        participation in a qualifying Valley fever clinical trial (as 
        defined in section 2709A(b)(4) of the Public Health Service 
        Act), including travel and incidental expenses, regardless of 
        whether such items and services are furnished by a 
        participating provider under the Medicaid program (other than a 
        provider excluded from participation in such program under 
        section 1128) or whether such items and services are furnished 
        in another State; and''.
    (b) Reduction in FMAP for States That Do Not Provide Coverage.--
Section 1905 of the Social Security Act (42 U.S.C. 1396d) is amended--
            (1) in subsection (b), by striking ``and (ff)'' and 
        inserting ``(ff), and (gg)''; and
            (2) by adding at the end the following new subsection:
    ``(gg) Reduction in FMAP for States That Do Not Provide Coverage 
for Certain Items and Services.--With respect to a calendar quarter 
beginning on or after January 1, 2021, the Federal medical assistance 
percentage otherwise determined under subsection (b) for a State that 
does not provide coverage for items and services described in 
subsection (a)(30) that are furnished during such quarter shall be 
reduced by 5 percentage points.''.
    (c) Ensuring Access for Medicaid Expansion Population.--Section 
1937(b)(5) of such Act is amended by inserting before the period at the 
end the following: ``, and beginning January 1, 2021, coverage of items 
and services described in section 1905(a)(30)''.
    (d) Prohibition on Imposition of Costsharing Requirements.--Title 
XIX of the Social Security Act (42 U.S.C. 1396 et seq.) is amended--
            (1) in section 1916(a)(2)--
                    (A) in subparagraph (D), by striking ``or'' at the 
                end;
                    (B) in subparagraph (E), by striking ``; and'' at 
                the end and inserting ``, or''; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(F) items and services described in section 
                1905(a)(30); and''; and
            (2) in section 1916A(b)(3)(B), by adding at the end the 
        following new clause:
                            ``(xi) Items and services described in 
                        section 1905(a)(30).''.
    (e) Continuous Coverage for Individuals Who Lose Medicaid 
Eligibility Based on Income.--Section 1902(e) of the Social Security 
Act (42 U.S.C. 1396a(e)) is amended by adding at the end the following 
new paragraph:
            ``(16) Continuous coverage for items and services furnished 
        in connection with qualifying valley fever clinical trials.--In 
        the case of an individual who is eligible for medical 
        assistance under the State plan (or a waiver of such plan) 
        based on the application of modified adjusted gross income 
        under paragraph (14)(A), who while so eligible is furnished 
        items and services described in section 1905(a)(30) in 
        connection with participation in a qualifying Valley fever 
        clinical trial (as defined in section 2709A(b)(4) of the Public 
        Health Service Act), and who while so furnished such items and 
        services loses eligibility for such medical assistance due to a 
        change in income of the family of which such individual is a 
        member, such individual shall be deemed to continue to be an 
        individual eligible for such medical assistance, without regard 
        to such change in income, only with respect to such items and 
        services through the end of the month in which such qualifying 
        Valley fever clinical trial ends.''.
    (f) Effective Date.--
            (1) In general.--The amendments made by this section shall 
        apply with respect to items and services furnished, and 
        eligibility determinations made, on or after January 1, 2021.
            (2) Exception for state legislation.--In the case of a 
        State plan under title XIX of the Social Security Act (42 
        U.S.C. 1396 et seq.) that the Secretary of Health and Human 
        Services determines requires State legislation in order for the 
        respective plan to meet any requirement imposed by amendments 
        made by this section, the respective plan shall not be regarded 
        as failing to comply with the requirements of such title solely 
        on the basis of its failure to meet such an additional 
        requirement before the first day of the first calendar quarter 
        beginning after the close of the first regular session of the 
        State legislature that begins after the date of the enactment 
        of this Act. For purposes of the previous sentence, in the case 
        of a State that has a 2-year legislative session, each year of 
        the session shall be considered to be a separate regular 
        session of the State legislature.

SEC. 5. REQUIREMENT FOR GROUP HEALTH PLANS AND HEALTH INSURANCE ISSUERS 
              TO PROVIDE COVERAGE FOR ITEMS AND SERVICES FURNISHED IN 
              CONNECTION WITH QUALIFYING VALLEY FEVER CLINICAL TRIALS.

    (a) In General.--Subpart I of part A of title XXVII of the Public 
Health Service Act (42 U.S.C. 300gg et seq.) is amended--
            (1) by redesignating the second section 2709 as section 
        2710; and
            (2) by inserting after the first section 2709 the following 
        new section:

``SEC. 2709A. COVERAGE FOR INDIVIDUALS PARTICIPATING IN QUALIFYING 
              VALLEY FEVER CLINICAL TRIALS.

    ``(a) In General.--Notwithstanding section 2709, a group health 
plan or health insurance issuer offering group or individual health 
insurance coverage shall, with respect to an enrollee of such plan or 
coverage, respectively, provide coverage for any item or service 
furnished to such enrollee in connection with such enrollee's 
participation in a qualifying Valley fever clinical trial, including 
travel and incidental expenses--
            ``(1) without regard to whether such item or service is 
        furnished by a participating provider or participating facility 
        with respect to such item or service; and
            ``(2) in a manner so that, if such item or service is 
        furnished to such enrollee by a nonparticipating provider or 
        nonparticipating facility, the cost-sharing requirement 
        (expressed as a copayment amount or coinsurance rate) is not 
        greater than the requirement that would apply if such item or 
        service were furnished by a participating provider or 
        participating facility.
    ``(b) Definitions.--In this section:
            ``(1) Nonparticipating facility; participating facility.--
                    ``(A) Nonparticipating facility.--The term 
                `nonparticipating facility' means, with respect to an 
                item or service and a group health plan or group or 
                individual health insurance coverage, a health care 
                facility that does not have a contractual relationship 
                with the sponsor of such plan or issuer of such 
                coverage for furnishing such item or service under the 
                plan or coverage.
                    ``(B) Participating facility.--The term 
                `participating facility' means, with respect to an item 
                or service and a group health plan or group or 
                individual health insurance coverage, a health care 
                facility that has a contractual relationship with the 
                sponsor of such plan or issuer of such coverage for 
                furnishing such item or service under the plan or 
                coverage.
            ``(2) Nonparticipating provider; participating provider.--
                    ``(A) Nonparticipating provider.--The term 
                `nonparticipating provider' means, with respect to an 
                item or service and a group health plan or group or 
                individual health insurance coverage, a physician or 
                other health care provider who is acting within the 
                scope of practice of that provider's license or 
                certification under applicable State law and who does 
                not have a contractual relationship with the sponsor of 
                such plan or issuer of such coverage for furnishing 
                such item or service under the plan or coverage.
                    ``(B) Participating provider.--The term 
                `participating provider' means, with respect to an item 
                or service and a group health plan or group or 
                individual health insurance coverage, a physician or 
                other health care provider who is acting within the 
                scope of practice of that provider's license or 
                certification under applicable State law and who has a 
                contractual relationship with the sponsor of such plan 
                or issuer of such coverage for furnishing such item or 
                service under the plan or coverage.
            ``(3) Qualifying valley fever clinical trial.--
                    ``(A) In general.--The term `qualifying Valley 
                fever clinical trial' means a phase I, phase II, phase 
                III, or phase IV clinical trial that is conducted in 
                relation to the prevention, detection, or treatment of 
                Valley fever (as defined in section 399V-7) and is 
                described in any of the following clauses:
                            ``(i) The study or investigation is 
                        approved or funded (which may include funding 
                        through in-kind contributions) by one or more 
                        of the following:
                                    ``(I) The National Institutes of 
                                Health.
                                    ``(II) The Centers for Disease 
                                Control and Prevention.
                                    ``(III) The Agency for Healthcare 
                                Research and Quality.
                                    ``(IV) The Centers for Medicare & 
                                Medicaid Services.
                                    ``(V) A cooperative group or center 
                                of any of the entities described in 
                                subclauses (I) through (IV) or the 
                                Department of Defense or the Department 
                                of Veterans Affairs.
                                    ``(VI) A qualified non-governmental 
                                research entity identified in the 
                                guidelines issued by the National 
                                Institutes of Health for center support 
                                grants.
                                    ``(VII) Any of the following if the 
                                conditions described in subparagraph 
                                (B) are met:
                                            ``(aa) The Department of 
                                        Veterans Affairs.
                                            ``(bb) The Department of 
                                        Defense.
                                            ``(cc) The Department of 
                                        Energy.
                            ``(ii) The clinical trial is conducted 
                        under an investigational new drug application 
                        reviewed by the Food and Drug Administration.
                            ``(iii) The clinical trial is a drug trial 
                        that is exempt from having such an 
                        investigational new drug application.
                    ``(B) Conditions.--For purposes of subparagraph 
                (A)(i)(VII), the conditions described in this 
                subparagraph, with respect to a clinical trial approved 
                or funded by an entity described in such subparagraph 
                (A)(i)(VII), are that the clinical trial has been 
                reviewed and approved through a system of peer review 
                that the Secretary determines--
                            ``(i) to be comparable to the system of 
                        peer review of studies and investigations used 
                        by the National Institutes of Health; and
                            ``(ii) assures unbiased review of the 
                        highest scientific standards by qualified 
                        individuals with no interest in the outcome of 
                        the review.''.
    (b) Effective Date.--The amendments made by this section shall 
apply with respect to plan years beginning on or after January 1, 2021.

SEC. 6. MEDICARE COVERAGE OF ITEMS AND SERVICES FURNISHED IN CONNECTION 
              WITH QUALIFYING VALLEY FEVER CLINICAL TRIALS.

    (a) Coverage.--Section 1861(s)(2) of the Social Security Act (42 
U.S.C. 1395x(s)(2)) is amended--
            (1) in subparagraph (GG), by striking ``and'' at the end;
            (2) in subparagraph (HH), by striking the period at the end 
        and inserting ``; and''; and
            (3) by adding at the end the following new subparagraph:
            ``(II) items and services furnished in connection with 
        participation in a qualifying Valley fever clinical trial (as 
        defined in section 2709A(b)(4) of the Public Health Service 
        Act), including travel and incidental expenses;''.
    (b) Payment.--Section 1833(a)(1) of the Social Security Act (42 
U.S.C. 1395l(a)(1)) is amended--
            (1) by striking ``and (CC)'' and inserting ``(CC)''; and
            (2) by inserting before the semicolon at the end the 
        following: ``, and (DD) with respect to items and services 
        described in section 1861(s)(2)(II), the amount paid shall be 
        100 percent of the lesser of the actual charge for the services 
        or the amount determined under the payment basis determined 
        under section 1848''.
                                 <all>
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