I 

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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘End Valley Fever Now 

5 Act’’. 


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1 SEC. 2. GRANTS TO DEVELOP PROGRAMS TO INCREASE 

2 HEALTH CARE PROVIDERS’ AWARENESS OF 

3 VALLEY FEVER. 

4 Part P of title III of the Public Health Service Act 

5 (42 U.S.C. 280g et seq.) is amended by adding at the end 

6 the following: 

7 ‘‘SEC. 399V–7. GRANTS TO DEVELOP PROGRAMS TO IN8 CREASE HEALTH CARE PROVIDERS’ AWARE9 NESS OF VALLEY FEVER. 

10 ‘‘(a) IN GENERAL.—The Secretary, acting through 

11 the Administrator of the Health Resources and Services 

12 Administration and in consultation with the Director of 

13 the Centers for Disease Control and Prevention, shall 

14 make awards of grants or cooperative agreements to eligi15 ble entities to establish and carry out programs— 

16 ‘‘(1) to increase health care providers’ aware17 ness of Valley fever; and 

18 ‘‘(2) to educate and train health care providers 

19 on the diagnosis and treatment of Valley fever. 

20 ‘‘(b) USE OF FUNDS.—An eligible entity selected to 

21 receive a grant or contract under this section shall use 

22 amounts awarded under such a grant or contract to pro23 vide innovative supportive activities (which may include 

24 activities that do not rely on the use of broadband serv25 ices) to enhance education through distance learning, conVerDate Sep 11 2014 01:44 Dec 27, 2019 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H5438.IH H5438

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1 tinuing educational activities, collaborative conferences, 

2 and electronic and telelearning activities. 

3 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 

4 are authorized to be appropriated to carry out this section 

5 $1,000,000 for the period of fiscal years 2021 through 

6 2023, to remain available until expended. 

7 ‘‘(d) CONDITION.—A recipient of a grant under this 

8 section shall, as a condition on receipt of the grant, agree 

9 to develop curricula for the purposes specified in sub10 section (a) in coordination with local providers at hospitals 

11 and clinics. 

12 ‘‘(e) DEFINITIONS.—In this section: 

13 ‘‘(1) The term ‘eligible entity’ means— 

14 ‘‘(A) a State department of health (or 

15 similar State authority); 

16 ‘‘(B) an institution of higher education (as 

17 defined in section 101 of the Higher Education 

18 Act of 1965 (20 U.S.C. 1001)), including a 

19 medical school or continuing medical education 

20 program at such institution; 

21 ‘‘(C) an entity operating a graduate med22 ical residency training program under section 

23 340E or under section 340H; or 

24 ‘‘(D) a teaching hospital (as defined in sec25 tion 415.152 of title 42, Code of Federal ReguVerDate Sep 11 2014 01:44 Dec 27, 2019 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H5438.IH H5438

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1 lations) that has physicians and other medical 

2 providers with specialized knowledge in diag3 nosing and treating Valley fever. 

4 ‘‘(2) The term ‘Valley fever’ means the condi5 tion caused by Coccidioidomycosis.’’. 

6 SEC. 3. STUDY COMPARING DIFFERENT CASE DEFINITIONS 

7 USED TO IDENTIFY VALLEY FEVER. 

8 (a) IN GENERAL.—The Secretary of Health and 

9 Human Services, acting through the Director of the Cen10 ters for Disease Control and Prevention shall conduct a 

11 study comparing different case definitions used to identify 

12 valley fever. Such study shall include the efficacy of the 

13 methods being used to establish such case definitions and 

14 the cost effectiveness of such methods, including using the 

15 case definition for valley fever established by the Council 

16 of State and Territorial Epidemiologist. 

17 (b) VALLEY FEVER DEFINED.—In this Act, the term 

18 ‘‘Valley fever’’ has the meaning given the term in section 

19 399V–7 of the Public Health Service Act. 


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1 SEC. 4. ALLOWING STATES TO PROVIDE COVERAGE UNDER 

2 THE MEDICAID PROGRAM FOR ITEMS AND 

3 SERVICES FURNISHED IN CONNECTION WITH 

4 QUALIFYING VALLEY FEVER CLINICAL 

5 TRIALS. 

6 (a) IN GENERAL.—Section 1905(a) of the Social Se7 curity Act (42 U.S.C. 1396d(a)) is amended— 

8 (1) in paragraph (29), by striking ‘‘and’’ at the 

9 end; 

10 (2) by redesignating paragraph (30) as para11 graph (31); and 

12 (3) by inserting after paragraph (29) the fol13 lowing new paragraph: 

14 ‘‘(30) items and services furnished in connec15 tion with participation in a qualifying Valley fever 

16 clinical trial (as defined in section 2709A(b)(4) of 

17 the Public Health Service Act), including travel and 

18 incidental expenses, regardless of whether such items 

19 and services are furnished by a participating pro20 vider under the Medicaid program (other than a pro21 vider excluded from participation in such program 

22 under section 1128) or whether such items and serv23 ices are furnished in another State; and’’. 

24 (b) REDUCTION IN FMAP FOR STATES THAT DO

25 NOT PROVIDE COVERAGE.—Section 1905 of the Social 

26 Security Act (42 U.S.C. 1396d) is amended— 


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1 (1) in subsection (b), by striking ‘‘and (ff)’’ and 

2 inserting ‘‘(ff), and (gg)’’; and 

3 (2) by adding at the end the following new sub4 section: 

5 ‘‘(gg) REDUCTION IN FMAP FOR STATES THAT DO

6 NOT PROVIDE COVERAGE FOR CERTAIN ITEMS AND

7 SERVICES.—With respect to a calendar quarter beginning 

8 on or after January 1, 2021, the Federal medical assist9 ance percentage otherwise determined under subsection 

10 (b) for a State that does not provide coverage for items 

11 and services described in subsection (a)(30) that are fur12 nished during such quarter shall be reduced by 5 percent13 age points.’’. 

14 (c) ENSURING ACCESS FOR MEDICAID EXPANSION

15 POPULATION.—Section 1937(b)(5) of such Act is amend16 ed by inserting before the period at the end the following: 

17 ‘‘, and beginning January 1, 2021, coverage of items and 

18 services described in section 1905(a)(30)’’. 

19 (d) PROHIBITION ON IMPOSITION OF COSTSHARING

20 REQUIREMENTS.—Title XIX of the Social Security Act 

21 (42 U.S.C. 1396 et seq.) is amended— 

22 (1) in section 1916(a)(2)— 

23 (A) in subparagraph (D), by striking ‘‘or’’ 

24 at the end; 


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1 (B) in subparagraph (E), by striking ‘‘; 

2 and’’ at the end and inserting ‘‘, or’’; and 

3 (C) by adding at the end the following new 

4 subparagraph: 

5 ‘‘(F) items and services described in sec6 tion 1905(a)(30); and’’; and 

7 (2) in section 1916A(b)(3)(B), by adding at the 

8 end the following new clause: 

9 ‘‘(xi) Items and services described in 

10 section 1905(a)(30).’’. 

11 (e) CONTINUOUS COVERAGE FOR INDIVIDUALS WHO

12 LOSE MEDICAID ELIGIBILITY BASED ON INCOME.—Sec13 tion 1902(e) of the Social Security Act (42 U.S.C. 

14 1396a(e)) is amended by adding at the end the following 

15 new paragraph: 

16 ‘‘(16) CONTINUOUS COVERAGE FOR ITEMS AND

17 SERVICES FURNISHED IN CONNECTION WITH QUALI18 FYING VALLEY FEVER CLINICAL TRIALS.—In the 

19 case of an individual who is eligible for medical as20 sistance under the State plan (or a waiver of such 

21 plan) based on the application of modified adjusted 

22 gross income under paragraph (14)(A), who while so 

23 eligible is furnished items and services described in 

24 section 1905(a)(30) in connection with participation 

25 in a qualifying Valley fever clinical trial (as defined 


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1 in section 2709A(b)(4) of the Public Health Service 

2 Act), and who while so furnished such items and 

3 services loses eligibility for such medical assistance 

4 due to a change in income of the family of which 

5 such individual is a member, such individual shall be 

6 deemed to continue to be an individual eligible for 

7 such medical assistance, without regard to such 

8 change in income, only with respect to such items 

9 and services through the end of the month in which 

10 such qualifying Valley fever clinical trial ends.’’. 

11 (f) EFFECTIVE DATE.— 

12 (1) IN GENERAL.—The amendments made by 

13 this section shall apply with respect to items and 

14 services furnished, and eligibility determinations 

15 made, on or after January 1, 2021. 

16 (2) EXCEPTION FOR STATE LEGISLATION.—In 

17 the case of a State plan under title XIX of the So18 cial Security Act (42 U.S.C. 1396 et seq.) that the 

19 Secretary of Health and Human Services determines 

20 requires State legislation in order for the respective 

21 plan to meet any requirement imposed by amend22 ments made by this section, the respective plan shall 

23 not be regarded as failing to comply with the re24 quirements of such title solely on the basis of its 

25 failure to meet such an additional requirement beVerDate Sep 11 2014 01:44 Dec 27, 2019 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H5438.IH H5438

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1 fore the first day of the first calendar quarter begin2 ning after the close of the first regular session of the 

3 State legislature that begins after the date of the en4 actment of this Act. For purposes of the previous 

5 sentence, in the case of a State that has a 2-year 

6 legislative session, each year of the session shall be 

7 considered to be a separate regular session of the 

8 State legislature. 

9 SEC. 5. REQUIREMENT FOR GROUP HEALTH PLANS AND 

10 HEALTH INSURANCE ISSUERS TO PROVIDE 

11 COVERAGE FOR ITEMS AND SERVICES FUR12 NISHED IN CONNECTION WITH QUALIFYING 

13 VALLEY FEVER CLINICAL TRIALS. 

14 (a) IN GENERAL.—Subpart I of part A of title 

15 XXVII of the Public Health Service Act (42 U.S.C. 300gg 

16 et seq.) is amended— 

17 (1) by redesignating the second section 2709 as 

18 section 2710; and 

19 (2) by inserting after the first section 2709 the 

20 following new section: 

21 ‘‘SEC. 2709A. COVERAGE FOR INDIVIDUALS PARTICIPATING 

22 IN QUALIFYING VALLEY FEVER CLINICAL 

23 TRIALS. 

24 ‘‘(a) IN GENERAL.—Notwithstanding section 2709, a 

25 group health plan or health insurance issuer offering 


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1 group or individual health insurance coverage shall, with 

2 respect to an enrollee of such plan or coverage, respec3 tively, provide coverage for any item or service furnished 

4 to such enrollee in connection with such enrollee’s partici5 pation in a qualifying Valley fever clinical trial, including 

6 travel and incidental expenses— 

7 ‘‘(1) without regard to whether such item or 

8 service is furnished by a participating provider or 

9 participating facility with respect to such item or 

10 service; and 

11 ‘‘(2) in a manner so that, if such item or serv12 ice is furnished to such enrollee by a nonpartici13 pating provider or nonparticipating facility, the cost14 sharing requirement (expressed as a copayment 

15 amount or coinsurance rate) is not greater than the 

16 requirement that would apply if such item or service 

17 were furnished by a participating provider or partici18 pating facility. 

19 ‘‘(b) DEFINITIONS.—In this section: 

20 ‘‘(1) NONPARTICIPATING FACILITY; PARTICI21 PATING FACILITY.— 

22 ‘‘(A) NONPARTICIPATING FACILITY.—The 

23 term ‘nonparticipating facility’ means, with re24 spect to an item or service and a group health 

25 plan or group or individual health insurance 


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1 coverage, a health care facility that does not 

2 have a contractual relationship with the sponsor 

3 of such plan or issuer of such coverage for fur4 nishing such item or service under the plan or 

5 coverage. 

6 ‘‘(B) PARTICIPATING FACILITY.—The term 

7 ‘participating facility’ means, with respect to an 

8 item or service and a group health plan or 

9 group or individual health insurance coverage, a 

10 health care facility that has a contractual rela11 tionship with the sponsor of such plan or issuer 

12 of such coverage for furnishing such item or 

13 service under the plan or coverage. 

14 ‘‘(2) NONPARTICIPATING PROVIDER; PARTICI15 PATING PROVIDER.— 

16 ‘‘(A) NONPARTICIPATING PROVIDER.—The 

17 term ‘nonparticipating provider’ means, with re18 spect to an item or service and a group health 

19 plan or group or individual health insurance 

20 coverage, a physician or other health care pro21 vider who is acting within the scope of practice 

22 of that provider’s license or certification under 

23 applicable State law and who does not have a 

24 contractual relationship with the sponsor of 

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1 nishing such item or service under the plan or 

2 coverage. 

3 ‘‘(B) PARTICIPATING PROVIDER.—The 

4 term ‘participating provider’ means, with re5 spect to an item or service and a group health 

6 plan or group or individual health insurance 

7 coverage, a physician or other health care pro8 vider who is acting within the scope of practice 

9 of that provider’s license or certification under 

10 applicable State law and who has a contractual 

11 relationship with the sponsor of such plan or 

12 issuer of such coverage for furnishing such item 

13 or service under the plan or coverage. 

14 ‘‘(3) QUALIFYING VALLEY FEVER CLINICAL

15 TRIAL.— 

16 ‘‘(A) IN GENERAL.—The term ‘qualifying 

17 Valley fever clinical trial’ means a phase I, 

18 phase II, phase III, or phase IV clinical trial 

19 that is conducted in relation to the prevention, 

20 detection, or treatment of Valley fever (as de21 fined in section 399V–7) and is described in 

22 any of the following clauses: 

23 ‘‘(i) The study or investigation is ap24 proved or funded (which may include fundVerDate Sep 11 2014 01:44 Dec 27, 2019 Jkt 099200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H5438.IH H5438

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1 ing through in-kind contributions) by one 

2 or more of the following: 

3 ‘‘(I) The National Institutes of 

4 Health. 

5 ‘‘(II) The Centers for Disease 

6 Control and Prevention. 

7 ‘‘(III) The Agency for Healthcare 

8 Research and Quality. 

9 ‘‘(IV) The Centers for Medicare 

10 & Medicaid Services. 

11 ‘‘(V) A cooperative group or cen12 ter of any of the entities described in 

13 subclauses (I) through (IV) or the De14 partment of Defense or the Depart15 ment of Veterans Affairs. 

16 ‘‘(VI) A qualified non-govern17 mental research entity identified in 

18 the guidelines issued by the National 

19 Institutes of Health for center support 

20 grants. 

21 ‘‘(VII) Any of the following if the 

22 conditions described in subparagraph 

23 (B) are met: 

24 ‘‘(aa) The Department of 

25 Veterans Affairs. 


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1 ‘‘(bb) The Department of 

2 Defense. 

3 ‘‘(cc) The Department of 

4 Energy. 

5 ‘‘(ii) The clinical trial is conducted 

6 under an investigational new drug applica7 tion reviewed by the Food and Drug Ad8 ministration. 

9 ‘‘(iii) The clinical trial is a drug trial 

10 that is exempt from having such an inves11 tigational new drug application. 

12 ‘‘(B) CONDITIONS.—For purposes of sub13 paragraph (A)(i)(VII), the conditions described 

14 in this subparagraph, with respect to a clinical 

15 trial approved or funded by an entity described 

16 in such subparagraph (A)(i)(VII), are that the 

17 clinical trial has been reviewed and approved 

18 through a system of peer review that the Sec19 retary determines— 

20 ‘‘(i) to be comparable to the system of 

21 peer review of studies and investigations 

22 used by the National Institutes of Health; 

23 and 

24 ‘‘(ii) assures unbiased review of the 

25 highest scientific standards by qualified inVerDate Sep 11 2014 01:44 Dec 27, 2019 Jkt 099200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\H5438.IH H5438

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1 dividuals with no interest in the outcome 

2 of the review.’’. 

3 (b) EFFECTIVE DATE.—The amendments made by 

4 this section shall apply with respect to plan years begin5 ning on or after January 1, 2021. 

6 SEC. 6. MEDICARE COVERAGE OF ITEMS AND SERVICES 

7 FURNISHED IN CONNECTION WITH QUALI8 FYING VALLEY FEVER CLINICAL TRIALS. 

9 (a) COVERAGE.—Section 1861(s)(2) of the Social Se10 curity Act (42 U.S.C. 1395x(s)(2)) is amended— 

11 (1) in subparagraph (GG), by striking ‘‘and’’ at 

12 the end; 

13 (2) in subparagraph (HH), by striking the pe14 riod at the end and inserting ‘‘; and’’; and 

15 (3) by adding at the end the following new sub16 paragraph: 

17 ‘‘(II) items and services furnished in connection 

18 with participation in a qualifying Valley fever clinical 

19 trial (as defined in section 2709A(b)(4) of the Public 

20 Health Service Act), including travel and incidental 

21 expenses;’’. 

22 (b) PAYMENT.—Section 1833(a)(1) of the Social Se23 curity Act (42 U.S.C. 1395l(a)(1)) is amended— 

24 (1) by striking ‘‘and (CC)’’ and inserting 

25 ‘‘(CC)’’; and 


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1 (2) by inserting before the semicolon at the end 

2 the following: ‘‘, and (DD) with respect to items and 

3 services described in section 1861(s)(2)(II), the 

4 amount paid shall be 100 percent of the lesser of the 

5 actual charge for the services or the amount deter6 mined under the payment basis determined under 

7 section 1848’’. 

Æ 


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