I 

108TH CONGRESS 

1ST SESSION H. R. 2018

To provide the Secretary of Health and Human Services and the Secretary 

of Education with increased authority with respect to asthma programs, 

and to provide for increased funding for such programs. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 7, 2003

Mrs. LOWEY (for herself, Mr. HINCHEY, Mr. GREEN of Texas, Ms. NORTON, 

Ms. DELAURO, Mr. EMANUEL, Mrs. CHRISTENSEN, Mr. RANGEL, Mr. 

TOWNS, Mr. PALLONE, Mrs. MCCARTHY of New York, Mr. KILDEE, Mr. 

ENGEL, Mr. CLYBURN, Mr. NADLER, Ms. SCHAKOWSKY, and Mr. DAVIS

of Illinois) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on 

Education and the Workforce, 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 provide the Secretary of Health and Human Services 

and the Secretary of Education with increased authority 

with respect to asthma programs, and to provide for 

increased funding for such programs.

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 ‘‘Asthma Act’’. 
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1 SEC. 2. FINDINGS. 

2 The Congress finds as follows: 

3 (1) Despite improved therapies, the prevalence 

4 rate of asthma continues to rise, affecting an esti5 mated 17 million Americans; nearly 5 million under 

6 the age of 18. The prevalence of pediatric asthma 

7 has risen dramatically since 1980. Rates are increas8 ing for all ethnic groups, especially for African9 American and Hispanic children. 

10 (2) Asthma is the third leading cause of pre11 ventable hospitalizations. Improper diagnosis and 

12 poor management of asthma resulted in 1.6 million 

13 people being treated for asthma attacks in the emer14 gency room in 1995. 

15 (3) Asthma can be life-threatening if not prop16 erly managed. Most asthma-related deaths are pre17 ventable, yet such deaths continue to rise in the U.S. 

18 Each day, 14 Americans die of asthma. 

19 (4) The cost of asthma to the U.S. was $11.3 

20 billion in 1998, and the rise in asthma prevalence 

21 will lead to higher costs in the future. 

22 (5) With early recognition of the signs and 

23 symptoms of asthma, proper diagnosis and treat24 ment, and patient education and self-management, 

25 asthma is a controllable disease. 
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1 (6) Public health interventions have been prov2 en effective in the treatment and management of 

3 asthma. Population-based research supported by the 

4 National Institutes of Health (NIH) has effectively 

5 demonstrated the benefits of combining aggressive 

6 medical treatment with patient education to improve 

7 the management of asthma. The National Asthma 

8 Education and Prevention Program (NAEPP) helps 

9 raise awareness that asthma is a serious chronic dis10 ease, and helps promote more effective management 

11 of asthma through patient and professional edu12 cation. 

13 (7) The alarming rise in prevalence, asthma-re14 lated deaths, and expenditures demonstrate that, de15 spite extensive knowledge on effective asthma man16 agement strategies, current federal policy and fund17 ing regarding the education, treatment, and manage18 ment of asthma is inadequate. 

19 (8) Additional Federal direction, funding, and 

20 support is necessary to increase awareness of asth21 ma as a chronic illness, its symptoms, and the envi22 ronmental factors (indoor and outdoor) that affect 

23 the disease, as well as to promote education pro24 grams that teach patients how to better manage 

25 asthma. 
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1 SEC. 3. PROVISIONS REGARDING NATIONAL ASTHMA EDU2 CATION AND PREVENTION PROGRAM OF NA3 TIONAL HEART, LUNG, AND BLOOD INSTI4 TUTE. 

5 (a) ADDITIONAL FUNDING; EXPANSION OF PRO6 GRAM.—In addition to any other authorization of appro7 priations that is available to the National Heart, Lung, 

8 and Blood Institute for the purpose of carrying out the 

9 National Asthma Education and Prevention Program, 

10 there is authorized to be appropriated to such Institute 

11 for such purpose $4,100,000 for each of the fiscal years 

12 2004 through 2008. Amounts appropriated under the pre13 ceding sentence shall be expended to expand such Pro14 gram. 

15 (b) COORDINATING COMMITTEE.—

16 (1) REPORT TO CONGRESS.—With respect to 

17 the coordinating committee established for the Na18 tional Asthma Education and Prevention Program of 

19 the National Heart, Lung, and Blood Institute, such 

20 committee shall submit to the Congress a report 

21 that—

22 (A) contains a determination by the com23 mittee of the scope of the problem of asthma in 

24 the United States; 

25 (B) identifies all Federal programs that 

26 carry out asthma-related activities; and 
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1 (C) contains the recommendations of the 

2 committee for strengthening and better coordi3 nating the asthma-related activities of the Fed4 eral Government. 

5 (2) INCLUSION OF REPRESENTATIVE OF DE6 PARTMENT OF EDUCATION.—The Secretary of Edu7 cation or a designee of the Secretary shall be in8 cluded in the membership of the coordinating com9 mittee referred to in paragraph (1). 

10 SEC. 4. ASTHMA-RELATED ACTIVITIES OF CENTERS FOR 

11 DISEASE CONTROL AND PREVENTION. 

12 (a) EXPANSION OF PUBLIC HEALTH SURVEILLANCE

13 ACTIVITIES; PROGRAM FOR PROVIDING INFORMATION

14 AND EDUCATION TO PUBLIC.—The Secretary of Health 

15 and Human Services, acting through the Director of the 

16 Centers for Disease Control and Prevention, shall collabo17 rate with the States to expand the scope of—

18 (1) activities that are carried out to determine 

19 the incidence and prevalence of asthma; and 

20 (2) activities that are carried out to prevent the 

21 health consequences of asthma, including through 

22 the provision of information and education to the 

23 public regarding asthma, which may include the use 

24 of public service announcements through the media 
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1 and such other means as such Director determines 

2 to be appropriate. 

3 (b) COMPILATION OF DATA.—The Secretary of 

4 Health and Human Services, acting through the Director 

5 of the Centers for Disease Control and Prevention and in 

6 consultation with the National Asthma Education Preven7 tion Program Coordinating Committee, shall—

8 (1) conduct local asthma surveillance activities 

9 to collect data on the prevalence and severity of 

10 asthma and the quality of asthma management, in11 cluding—

12 (A) telephone surveys to collect sample 

13 household data on the local burden of asthma; 

14 and 

15 (B) health care facility specific surveillance 

16 to collect asthma data on the prevalence and se17 verity of asthma, and on the quality of asthma 

18 care; and 

19 (2) compile and annually publish data on—

20 (A) the prevalence of children suffering 

21 from asthma in each State; and 

22 (B) the childhood mortality rate associated 

23 with asthma nationally and in each State. 

24 (c) ADDITIONAL FUNDING.—In addition to any other 

25 authorization of appropriations that is available to the 
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1 Centers for Disease Control and Prevention for the pur2 pose of carrying out this section, there is authorized to 

3 be appropriated to such Centers for such purpose 

4 $8,200,000 for each of the fiscal years 2004 through 

5 2008. 

6 SEC. 5. GRANTS FOR COMMUNITY OUTREACH REGARDING 

7 ASTHMA INFORMATION, EDUCATION, AND 

8 SERVICES. 

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

10 Human Services (in this section referred to as the ‘‘Sec11 retary’’) may make grants to nonprofit private entities for 

12 projects to carry out, in communities identified by entities 

13 applying for the grants, outreach activities to provide for 

14 residents of the communities the following: 

15 (1) Information and education on asthma. 

16 (2) Referrals to health programs of public and 

17 nonprofit private entities that provide asthma-re18 lated services, including such services for low-income 

19 individuals. The grant may be expended to make ar20 rangements to coordinate the activities of such enti21 ties in order to establish and operate networks or 

22 consortia regarding such referrals. 

23 (b) PREFERENCES IN MAKING GRANTS.—In making 

24 grants under subsection (a), the Secretary shall give pref25 erence to applicants that will carry out projects under such 
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1 subsection in communities that are disproportionately af2 fected by asthma or underserved with respect to the activi3 ties described in such subsection and in which a significant 

4 number of low-income individuals reside. 

5 (c) EVALUATIONS.—A condition for a grant under 

6 subsection (a) is that the applicant for the grant agree 

7 to provide for the evaluation of the projects carried out 

8 under such subsection by the applicant to determine the 

9 extent to which the projects have been effective in carrying 

10 out the activities referred to in such subsection. 

11 (d) FUNDING.—For the purpose of carrying out this 

12 section, there is authorized to be appropriated $4,100,000 

13 for each of the fiscal years 2004 through 2008. 

14 SEC. 6. ACTION PLANS OF STATES REGARDING ASTHMA; FI15 NANCIAL INCENTIVES REGARDING CHIL16 DREN’S HEALTH INSURANCE PROGRAM. 

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

18 Human Services (in this section referred to as the ‘‘Sec19 retary’’) shall in accordance with subsection (b) carry out 

20 a program to encourage the States to implement plans to 

21 carry out activities to assist children with respect to asth22 ma in accordance with guidelines of the National Heart, 

23 Lung, and Blood Institute. 

24 (b) RELATION TO CHILDREN’S HEALTH INSURANCE

25 PROGRAM.—
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1 (1) IN GENERAL.—Subject to paragraph (2), if 

2 a State plan under title XXI of the Social Security 

3 Act provides for activities described in subsection (a) 

4 to an extent satisfactory to the Secretary, the Sec5 retary shall, with amounts appropriated under sub6 section (c), make a grant to the State involved to as7 sist the State in carrying out such activities. 

8 (2) REQUIREMENT OF MATCHING FUNDS.—

9 (A) IN GENERAL.—With respect to the 

10 costs of the activities to be carried out by a 

11 State pursuant to paragraph (1), the Secretary 

12 may make a grant under such paragraph only 

13 if the State agrees to make available (directly 

14 or through donations from public or private en15 tities) non-Federal contributions toward such 

16 costs in an amount that is not less than 50 per17 cent of the costs ($1 for each $1 of Federal 

18 funds provided in the grant). 

19 (B) DETERMINATION OF AMOUNT CON20 TRIBUTED.—Non-Federal contributions re21 quired in subparagraph (A) may be in cash or 

22 in kind, fairly evaluated, including plant, equip23 ment, or services. Amounts provided by the 

24 Federal Government, or services assisted or 

25 subsidized to any significant extent by the Fed-
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1 eral Government, may not be included in deter2 mining the amount of such non-Federal con3 tributions. 

4 (3) CRITERIA REGARDING ELIGIBILITY FOR

5 GRANT.—The Secretary shall publish in the Federal 

6 Register criteria describing the circumstances in 

7 which the Secretary will consider a State plan to be 

8 satisfactory for purposes of paragraph (1). 

9 (4) TECHNICAL ASSISTANCE.—With respect to 

10 State plans under title XXI of the Social Security 

11 Act, the Secretary, acting through the Director of 

12 the Centers for Disease Control and Prevention, 

13 shall make available to the States technical assist14 ance in developing the provisions of such plans that 

15 will provide for activities pursuant to paragraph (1). 

16 (c) FUNDING.—For the purpose of carrying out this 

17 section, there is authorized to be appropriated $4,100,000 

18 for each of the fiscal years 2004 through 2008. 

19 SEC. 7. ACTION PLANS OF LOCAL EDUCATIONAL AGENCIES 

20 REGARDING ASTHMA. 

21 (a) IN GENERAL.—. 

22 (1) SCHOOL-BASED ASTHMA ACTIVITIES.—The 

23 Secretary of Education (in this section referred to as 

24 the ‘‘Secretary’’), in consultation with the Director 

25 of the Centers for Disease Control and Prevention 
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1 and the Director of the National Institutes of 

2 Health, may make grants to local educational agen3 cies for programs to carry out at elementary and 

4 secondary schools specified in paragraph (2) asthma5 related activities for children who attend such 

6 schools. 

7 (2) ELIGIBLE SCHOOLS.—The elementary and 

8 secondary schools referred to in paragraph (1) are 

9 such schools that are located in communities with a 

10 significant number of low-income or underserved in11 dividuals (as defined by the Secretary). 

12 (b) DEVELOPMENT OF PROGRAMS.—Programs under 

13 subsection (a) shall include grants under which local edu14 cation agencies and State public health officials collabo15 rate to develop programs to improve the management of 

16 asthma in school settings. 

17 (c) CERTAIN GUIDELINES.—Programs under sub18 section (a) shall be carried out in accordance with applica19 ble guidelines or other recommendations of the National 

20 Institutes of Health (including the National Heart, Lung, 

21 and Blood Institute) and the Environmental Protection 

22 Agency. 

23 (d) CERTAIN ACTIVITIES.—Activities that may be 

24 carried out in programs under subsection (a) include the 

25 following: 
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1 (1) Identifying and working directly with local 

2 hospitals, community clinics, advocacy organizations, 

3 parent-teacher associations, and asthma coalitions. 

4 (2) Identifying asthmatic children and training 

5 them and their families in asthma self-management. 

6 (3) Purchasing asthma equipment. 

7 (4) Hiring school nurses. 

8 (5) Training teachers, nurses, coaches, and 

9 other school personnel in asthma-symptom recogni10 tion and emergency responses. 

11 (6) Simplifying procedures to improve students’ 

12 safe access to their asthma medications. 

13 (7) Such other asthma-related activities as the 

14 Secretary determines to be appropriate. 

15 (e) DEFINITIONS.—For purposes of this section, the 

16 terms ‘‘elementary school’’, ‘‘local educational agency’’, 

17 and ‘‘secondary school’’ have the meanings given such 

18 terms in the Elementary and Secondary Education Act of 

19 1965. 

20 (f) FUNDING.—For the purpose of carrying out this 

21 section, there is authorized to be appropriated $4,100,000 

22 for each of the fiscal years 2004 through 2008. 

23 SEC. 8. SENSE OF CONGRESS REGARDING HOSPITALS AND 

24 MANAGED CARE PLANS. 

25 It is the sense of the Congress that—
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1 (1) hospitals should be encouraged to offer 

2 asthma-related education and training to asthma pa3 tients and their families upon discharge from the 

4 hospital of such patients; 

5 (2) hospitals should, with respect to information 

6 on asthma, establish telephone services for patients 

7 and communicate with providers of primary health 

8 services; and 

9 (3) managed care organizations should—

10 (A) be encouraged to disseminate to health 

11 care providers asthma clinical practice guide12 lines developed or endorsed by the Public 

13 Health Service; 

14 (B) collect and maintain asthma data; and 

15 (C) offer asthma-related education and 

16 training to asthma patients and their families. 

17 SEC. 9. SENSE OF CONGRESS REGARDING IMPLEMENTA18 TION OF ACT. 

19 It is the sense of the Congress that all Federal, State, 

20 and local asthma-related activities should—

21 (1) promote the guidelines and other rec22 ommendations of the Public Health Service on asth23 ma diagnosis and management; and 

24 (2) be designed in consultation with national 

25 and local organizations representing the medical, 
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1 educational, and environmental communities, as well 

2 as advocates that represent those affected by asth3 ma.

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