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[House Report 108-606]
[From the U.S. Government Publishing Office]

108th Congress                                            Rept. 108-606
                        HOUSE OF REPRESENTATIVES
 2d Session                                                      Part 1

======================================================================

 
 ASTHMATIC SCHOOLCHILDREN'S TREATMENT AND HEALTH MANAGEMENT ACT OF 2004

                                _______
                                

                 July 14, 2004.--Ordered to be printed

                                _______
                                

    Mr. Barton of Texas, from the Committee on Energy and Commerce, 
                        submitted the following

                              R E P O R T

                        [To accompany H.R. 2023]

      [Including cost estimate of the Congressional Budget Office]

  The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 2023) to give a preference regarding States that 
require schools to allow students to self-administer medication 
to treat that student's asthma or anaphylaxis, and for other 
purposes, having considered the same, report favorably thereon 
with an amendment and recommend that the bill as amended do 
pass.

                                CONTENTS

                                                                   Page
Amendment........................................................     1
Purpose and Summary..............................................     3
Background and Need for Legislation..............................     3
Hearings.........................................................     4
Committee Consideration..........................................     4
Committee Votes..................................................     4
Committee Oversight Findings.....................................     4
Statement of General Performance Goals and Objectives............     4
New Budget Authority, Entitlement Authority, and Tax Expenditures     4
Committee Cost Estimate..........................................     5
Congressional Budget Office Estimate.............................     5
Federal Mandates Statement.......................................     6
Advisory Committee Statement.....................................     6
Constitutional Authority Statement...............................     6
Applicability to Legislative Branch..............................     6
Section-by-Section Analysis of the Legislation...................     6
Changes in Existing Law Made by the Bill, as Reported............     7
Exchange of Committee Correspondence.............................     9

                               Amendment

  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 ``Asthmatic Schoolchildren's Treatment 
and Health Management Act of 2004''.

SEC. 2. FINDINGS.

  The Congress finds the following:
          (1) Asthma is a chronic condition requiring lifetime, ongoing 
        medical intervention.
          (2) In 1980, 6,700,000 Americans had asthma.
          (3) In 2001, 20,300,000 Americans had asthma; 6,300,000 
        children under age 18 had asthma.
          (4) The prevalence of asthma among African-American children 
        was 40 percent greater than among Caucasian children, and more 
        than 26 percent of all asthma deaths are in the African-
        American population.
          (5) In 2000, there were 1,800,000 asthma-related visits to 
        emergency departments (more than 728,000 of these involved 
        children under 18 years of age).
          (6) In 2000, there were 465,000 asthma-related 
        hospitalizations (214,000 of these involved children under 18 
        years of age).
          (7) In 2000, 4,487 people died from asthma, and of these 223 
        were children.
          (8) According to the Centers for Disease Control and 
        Prevention, asthma is a common cause of missed school days, 
        accounting for approximately 14,000,000 missed school days 
        annually.
          (9) According to the New England Journal of Medicine, working 
        parents of children with asthma lose an estimated 
        $1,000,000,000 a year in productivity.
          (10) At least 30 States have legislation protecting the 
        rights of children to carry and self-administer asthma metered-
        dose inhalers, and at least 18 States expand this protection to 
        epinephrine auto-injectors.
          (11) Tragic refusals of schools to permit students to carry 
        their inhalers and auto-injectable epinephrine have occurred, 
        some resulting in death and spawning litigation.
          (12) School district medication policies must be developed 
        with the safety of all students in mind. The immediate and 
        correct use of asthma inhalers and auto-injectable epinephrine 
        are necessary to avoid serious respiratory complications and 
        improve health care outcomes.
          (13) No school should interfere with the patient-physician 
        relationship.
          (14) Anaphylaxis, or anaphylactic shock, is a systemic 
        allergic reaction that can kill within minutes. Anaphylaxis 
        occurs in some asthma patients. According to the American 
        Academy of Allergy, Asthma, and Immunology, people who have 
        experienced symptoms of anaphylaxis previously are at risk for 
        subsequent reactions and should carry an epinephrine auto-
        injector with them at all times, if prescribed.
          (15) An increasing number of students and school staff have 
        life-threatening allergies. Exposure to the affecting allergen 
        can trigger anaphylaxis. Anaphylaxis requires prompt medical 
        intervention with an injection of epinephrine.

SEC. 3. PREFERENCE FOR STATES THAT ALLOW STUDENTS TO SELF-ADMINISTER 
                    MEDICATION TO TREAT ASTHMA AND ANAPHYLAXIS.

  (a) Amendments.--Section 399L of the Public Health Service Act (42 
U.S.C. 280g) is amended--
          (1) by redesignating subsection (d) as subsection (e); and
          (2) by inserting after subsection (c) the following:
  ``(d) Preference for States That Allow Students to Self-Administer 
Medication to Treat Asthma and Anaphylaxis.--
          ``(1) Preference.--The Secretary, in making any grant under 
        this section or any other grant that is asthma-related (as 
        determined by the Secretary) to a State, shall give preference 
        to any State that satisfies the following:
                  ``(A) In general.--The State must require that each 
                public elementary school and secondary school in that 
                State will grant to any student in the school an 
                authorization for the self-administration of medication 
                to treat that student's asthma or anaphylaxis, if--
                          ``(i) a health care practitioner prescribed 
                        the medication for use by the student during 
                        school hours and instructed the student in the 
                        correct and responsible use of the medication;
                          ``(ii) the student has demonstrated to the 
                        health care practitioner (or such 
                        practitioner's designee) and the school nurse 
                        (if available) the skill level necessary to use 
                        the medication and any device that is necessary 
                        to administer such medication as prescribed;
                          ``(iii) the health care practitioner 
                        formulates a written treatment plan for 
                        managing asthma or anaphylaxis episodes of the 
                        student and for medication use by the student 
                        during school hours; and
                          ``(iv) the student's parent or guardian has 
                        completed and submitted to the school any 
                        written documentation required by the school, 
                        including the treatment plan formulated under 
                        clause (iii) and other documents related to 
                        liability.
                  ``(B) Scope.--An authorization granted under 
                subparagraph (A) must allow the student involved to 
                possess and use his or her medication--
                          ``(i) while in school;
                          ``(ii) while at a school-sponsored activity, 
                        such as a sporting event; and
                          ``(iii) in transit to or from school or 
                        school-sponsored activities.
                  ``(C) Duration of authorization.--An authorization 
                granted under subparagraph (A)--
                          ``(i) must be effective only for the same 
                        school and school year for which it is granted; 
                        and
                          ``(ii) must be renewed by the parent or 
                        guardian each subsequent school year in 
                        accordance with this subsection.
                  ``(D) Backup medication.--The State must require that 
                backup medication, if provided by a student's parent or 
                guardian, be kept at a student's school in a location 
                to which the student has immediate access in the event 
                of an asthma or anaphylaxis emergency.
                  ``(E) Maintenance of information.--The State must 
                require that information described in subparagraphs 
                (A)(iii) and (A)(iv) be kept on file at the student's 
                school in a location easily accessible in the event of 
                an asthma or anaphylaxis emergency.
          ``(2) Rule of construction.--Nothing in this subsection 
        creates a cause of action or in any other way increases or 
        diminishes the liability of any person under any other law.
          ``(3) Definitions.--For purposes of this subsection:
                  ``(A) The terms `elementary school' and `secondary 
                school' have the meaning given to those terms in 
                section 9101 of the Elementary and Secondary Education 
                Act of 1965.
                  ``(B) The term `health care practitioner' means a 
                person authorized under law to prescribe drugs subject 
                to section 503(b) of the Federal Food, Drug, and 
                Cosmetic Act.
                  ``(C) The term `medication' means a drug as that term 
                is defined in section 201 of the Federal Food, Drug, 
                and Cosmetic Act and includes inhaled bronchodilators 
                and auto-injectable epinephrine.
                  ``(D) The term `self-administration' means a 
                student's discretionary use of his or her prescribed 
                asthma or anaphylaxis medication, pursuant to a 
                prescription or written direction from a health care 
                practitioner.''.
  (b) Applicability.--The amendments made by this section shall apply 
only with respect to grants made on or after the date that is 9 months 
after the date of the enactment of this Act.

SEC. 4. SENSE OF CONGRESS COMMENDING CDC FOR ITS STRATEGIES FOR 
                    ADDRESSING ASTHMA WITHIN A COORDINATED SCHOOL 
                    HEALTH PROGRAM.

  The Congress--
          (1) commends the Centers for Disease Control and Prevention 
        for identifying and creating ``Strategies for Addressing Asthma 
        Within a Coordinated School Program'' for schools to address 
        asthma; and
          (2) encourages all schools to review these strategies and 
        adopt policies that will best meet the needs of their student 
        population.

                          Purpose and Summary

    H.R. 2023 directs the Secretary of Health and Human 
Services to give preference when making asthma-related grants 
to States that require schools to allow students to self-
administer medications for asthma and/or anaphylaxis.

                  Background and Need for Legislation

    Asthma, a chronic lung disease, affects an estimated 17 
million Americans. When asthma strikes, airways in the lungs 
become inflamed and constricted, causing coughing, wheezing, 
and difficulty breathing. Each year, nearly 500,000 Americans 
are hospitalized and more than 5,000 die from asthma. Several 
medications, when properly administered in a timely fashion, 
are now available to treat asthma and/or anaphylaxis.
    Some schools, however, do not permit students to self-
administer medication for asthma or anaphylaxis--even though 
the parent or guardian of the student has authorized the use of 
the medication and it is recommended by a health care 
provider--resulting in an unnecessary delay of potentially 
life-saving treatments. H.R. 2023 directs the Secretary of 
Health and Human Services to give preference when making 
asthma-related grants to States that require schools to allow 
students to self-administer medications for asthma and/or 
anaphylaxis.

                                Hearings

    The Committee on Energy and Commerce has not held hearings 
on the legislation.

                        Committee Consideration

    On Tuesday, June 15, 2004, the Subcommittee on Health met 
in open markup session and approved H.R. 2023 for Full 
Committee consideration, as amended, by a voice vote, a quorum 
being present. On Thursday, June 24, 2004, the Full Committee 
met in open markup session and favorably ordered H.R. 2023 
reported, as amended, by a voice vote, a quorum being present.

                            Committee Votes

    There were no record votes taken in connection with 
ordering H.R. 2023 reported. A motion by Mr. Pickering to order 
H.R. 2023 reported to the House, as amended, was agreed to by a 
voice vote.

                      Committee Oversight Findings

    Pursuant to clause 3(c)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee has not held oversight 
or legislative hearings on this legislation.

         Statement of General Performance Goals and Objectives

    H.R. 2023 directs the Secretary of Health and Human 
Services to give preference when making asthma-related grants 
to States that require schools to allow students to self-
administer medications for asthma and/or anaphylaxis.

   New Budget Authority, Entitlement Authority, and Tax Expenditures

    In compliance with clause 3(c)(2) of rule XIII of the Rules 
of the House of Representatives, the Committee finds that H.R. 
2023, the Asthmatic Schoolchildren's Treatment and Health 
Management Act, would result in no new or increased budget 
authority, entitlement authority, or tax expenditures or 
revenues.

                        Committee Cost Estimate

    The Committee adopts as its own the cost estimate prepared 
by the Director of the Congressional Budget Office pursuant to 
section 402 of the Congressional Budget Act of 1974.

                  Congressional Budget Office Estimate

    Pursuant to clause 3(c)(3) of rule XIII of the Rules of the 
House of Representatives, the following is the cost estimate 
provided by the Congressional Budget Office pursuant to section 
402 of the Congressional Budget Act of 1974:

                                     U.S. Congress,
                               Congressional Budget Office,
                                      Washington, DC, July 9, 2004.
Hon. Joe Barton,
Chairman, Committee on Energy and Commerce,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 2023, the 
Asthmatic Schoolchildren's Treatment and Health Management Act 
of 2004.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact are Tim 
Gronniger (for federal costs), and Leo Lex (for the state and 
local impact).
            Sincerely,
                                       Douglas Holtz-Eakin,
                                                          Director.
    Enclosure.

H.R. 2023--Asthmatic Schoolchildren's Treatment and Health Management 
        Act of 2004

    H.R. 2023 would modify the Public Health Service Act by 
directing the Secretary of Health and Human Services, in making 
any asthma-related grant to a state, to give preference to 
states that require schools to permit students to self-
administer medication for asthma and anaphylaxis.
    The bill would not change the purposes for which the 
Secretary makes asthma-related grants. CBO estimates that 
enacting H.R. 2023 would not have a significant effect on the 
federal budget. Enacting H.R. 2023 would not affect direct 
spending or revenues.
    H.R. 2023 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act, but it 
would alter conditions for the Children's Asthma Treatment 
Grants Program and other asthma-related grants, giving 
preferences to states who allow schoolchildren to self-
administer asthma medication. While the bill would not alter 
the total amount of grants available, the new preferences could 
change the distribution of funds among states.
    The CBO staff contacts are Tim Gronniger (for federal 
costs), and Leo Lex (for the state and local impact). This 
estimate was approved by Peter H. Fontaine, Deputy Assistant 
Director for Budget Analysis.

                       Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates prepared by the Director of the Congressional Budget 
Office pursuant to section 423 of the Unfunded Mandates Reform 
Act.

                      Advisory Committee Statement

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act were created by this 
legislation.

                   Constitutional Authority Statement

    Pursuant to clause 3(d)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee finds that the 
Constitutional authority for this legislation is provided in 
Article I, section 8, clause 3, which grants Congress the power 
to regulate commerce with foreign nations, among the several 
States, and with the Indian tribes.

                  Applicability to Legislative Branch

    The Committee finds that the legislation does not relate to 
the terms and conditions of employment or access to public 
services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

             Section-by-Section Analysis of the Legislation

Section 1. Short title

    Section 1 designates the short title as the ``Asthmatic 
Schoolchildren's Treatment and Health Management Act of 2004.''

Section 2. Findings

    Section 2 states the findings of the bill.

Section 3. Preference for States that allow students to self-administer 
        medication to treat asthma and anaphylaxis

    Section 3 requires the Secretary of Health and Human 
Services when making any grant that is asthma-related, as 
determined by the Secretary, to give preference to States that 
require public elementary and secondary schools to permit 
students to self-administer medication to treat asthma or 
anaphylaxis. Specifically, the bill requires that the schools 
permit self-administration of medication if the following 
criteria are met: (1) a health care practitioner prescribed the 
medication for use by the student during school hours and 
instructed the student in the correct and responsible use of 
the medication; (2) the student has demonstrated to the health 
care practitioner and the school nurse, if available, the skill 
level necessary to use the medication and any device that is 
necessary to administer such medication as prescribed; (3) the 
health care practitioner formulated a written treatment plan 
for managing asthma or anaphylaxis episodes of the student and 
for medication use by the student during school hours; and, (4) 
the student's parent or guardian has completed and submitted to 
the school any written documentation required by the school, 
including the treatment plan and other documents related to 
liability.
    With regard to the fourth provision, the Committee does not 
intend to direct the States to require any particular form or 
document, nor to increase overall paperwork burdens. Rather, 
the Committee intends for this provision to emphasize the 
mutual compliance of parents and schools regarding all required 
documentation. For example, if a State law or a school asks 
parents to sign a waiver of liability, or some other document 
relating to the liability of a school, this provision simply 
states that the appropriate documentation should be filed.
    The school must permit the student to possess and use his 
or her medication while in school, while at a school-sponsored 
activity, and in transit to or from school or school-sponsored 
activities. The school authorization for the student to carry 
the medication is effective for that school and the same school 
year it is granted, and must be renewed by the parent or 
guardian each subsequent school year. The State must also 
require that backup medication, if provided by a student's 
parent or guardian, be kept at the school in a location with 
immediate access. The State must also require that all 
documentation related to the student's use of asthma and/or 
anaphylaxis medication be kept on file at the student's school 
in a location easily accessible in the event of an asthma or 
anaphylaxis emergency.
    Section 3 clearly states that nothing in the bill creates a 
cause of action or in any other way increased on diminishes the 
liability of any person under any other law. Section 3 also 
includes definitions of terms used in the legislation.

Section 4. Sense of Congress commending CDC for its strategies for 
        addressing asthma within a Coordinated School Health Program

    Section 4 states that Congress commends the Centers for 
Disease Control and Prevention for identifying and creating 
``Strategies for Addressing Asthma Within a Coordinated School 
Program'' for schools. Congress also encourages all schools to 
review these strategies and adopt policies that will best meet 
the needs of their student population.

         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 omitted is enclosed in black brackets, new 
matter is printed in italic, existing law in which no change is 
proposed is shown in roman):

             SECTION 399L OF THE PUBLIC HEALTH SERVICE ACT

SEC. 399L. CHILDREN'S ASTHMA TREATMENT GRANTS PROGRAM.

  (a) * * *

           *       *       *       *       *       *       *

  (d) Preference for States That Allow Students to Self-
Administer Medication to Treat Asthma and Anaphylaxis.--
          (1) Preference.--The Secretary, in making any grant 
        under this section or any other grant that is asthma-
        related (as determined by the Secretary) to a State, 
        shall give preference to any State that satisfies the 
        following:
                  (A) In general.--The State must require that 
                each public elementary school and secondary 
                school in that State will grant to any student 
                in the school an authorization for the self-
                administration of medication to treat that 
                student's asthma or anaphylaxis, if--
                          (i) a health care practitioner 
                        prescribed the medication for use by 
                        the student during school hours and 
                        instructed the student in the correct 
                        and responsible use of the medication;
                          (ii) the student has demonstrated to 
                        the health care practitioner (or such 
                        practitioner's designee) and the school 
                        nurse (if available) the skill level 
                        necessary to use the medication and any 
                        device that is necessary to administer 
                        such medication as prescribed;
                          (iii) the health care practitioner 
                        formulates a written treatment plan for 
                        managing asthma or anaphylaxis episodes 
                        of the student and for medication use 
                        by the student during school hours; and
                          (iv) the student's parent or guardian 
                        has completed and submitted to the 
                        school any written documentation 
                        required by the school, including the 
                        treatment plan formulated under clause 
                        (iii) and other documents related to 
                        liability.
                  (B) Scope.--An authorization granted under 
                subparagraph (A) must allow the student 
                involved to possess and use his or her 
                medication--
                          (i) while in school;
                          (ii) while at a school-sponsored 
                        activity, such as a sporting event; and
                          (iii) in transit to or from school or 
                        school-sponsored activities.
                  (C) Duration of authorization.--An 
                authorization granted under subparagraph (A)--
                          (i) must be effective only for the 
                        same school and school year for which 
                        it is granted; and
                          (ii) must be renewed by the parent or 
                        guardian each subsequent school year in 
                        accordance with this subsection.
                  (D) Backup medication.--The State must 
                require that backup medication, if provided by 
                a student's parent or guardian, be kept at a 
                student's school in a location to which the 
                student has immediate access in the event of an 
                asthma or anaphylaxis emergency.
                  (E) Maintenance of information.--The State 
                must require that information described in 
                subparagraphs (A)(iii) and (A)(iv) be kept on 
                file at the student's school in a location 
                easily accessible in the event of an asthma or 
                anaphylaxis emergency.
          (2) Rule of construction.--Nothing in this subsection 
        creates a cause of action or in any other way increases 
        or diminishes the liability of any person under any 
        other law.
          (3) Definitions.--For purposes of this subsection:
                  (A) The terms ``elementary school'' and 
                ``secondary school'' have the meaning given to 
                those terms in section 9101 of the Elementary 
                and Secondary Education Act of 1965.
                  (B) The term ``health care practitioner'' 
                means a person authorized under law to 
                prescribe drugs subject to section 503(b) of 
                the Federal Food, Drug, and Cosmetic Act.
                  (C) The term ``medication'' means a drug as 
                that term is defined in section 201 of the 
                Federal Food, Drug, and Cosmetic Act and 
                includes inhaled bronchodilators and auto-
                injectable epinephrine.
                  (D) The term ``self-administration'' means a 
                student's discretionary use of his or her 
                prescribed asthma or anaphylaxis medication, 
                pursuant to a prescription or written direction 
                from a health care practitioner.
  [(d)] (e) Authorization of Appropriations.--For the purpose 
of carrying out this section, there are authorized to be 
appropriated such sums as may be necessary for each of the 
fiscal years 2001 through 2005.

           *       *       *       *       *       *       *

                  Exchange of Committee Correspondence

                          House of Representatives,
                          Committee on Energy and Commerce,
                                     Washington, DC, July 14, 2004.
Hon. John A. Boehner,
Chairman, Committee on Education and the Workforce, House of 
        Representatives, Rayburn House Office Building, Washington, DC.
    Dear Chairman Boehner: Thank you for your letter regarding 
H.R. 2023, the ``Asthmatic Schoolchildren's Treatment and 
Health Management Act of 2003.'' As you noted, the Committee on 
Education and the Workforce was named as a Committee of 
jurisdiction upon introduction.
    I appreciate your willingness not to seek a continued 
referral on H.R. 2023, or object to the scheduling of the bill 
for consideration in the House of Representatives. I agree that 
your decision to forego action on the bill will not prejudice 
the Committee on Education and the Workforce with respect to 
its jurisdictional prerogatives on this or similar legislation.
    I will include a copy of your letter and this response in 
the Committee's report to accompany H.R. 2023.
            Sincerely,
                                                Joe Barton,
                                                          Chairman.
                                ------                                

                          House of Representatives,
                  Committee on Education and the Workforce,
                                     Washington, DC, July 13, 2004.
Hon. Joe Barton,
Chairman, Committee on Energy and Commerce, Rayburn House Office 
        Building, Washington, DC.
    Dear Chairman Barton: I am writing to confirm our mutual 
understanding with respect to consideration of H.R. 2023, the 
Asthmatic Schoolchildren's Treatment and Health Management Act 
of 2003, which the Committee on Energy and Commerce ordered 
favorably reported on June 24, 2004. This bill was referred to 
the Committee on Energy and Commerce and in addition to the 
Committee on Education and the Workforce.
    Given the importance of this legislation, I do not intend 
to ask for continued referral of H.R. 2023, nor will I object 
to the scheduling of this bill for consideration in the House 
of Representatives. However, I do so only with the 
understanding that this procedural route should not be 
construed to prejudice the Committee on Education and the 
Workforce's jurisdictional interest and prerogatives on these 
provisions or any other similar legislation and will not be 
considered as precedent for consideration of matters of 
jurisdictional interest to my Committee in the future. 
Furthermore, should these or similar provisions be considered 
in a conference with the Senate, I would expect Members of the 
Committee on Education and the Workforce be appointed to the 
conference committee on those provisions.
    Finally, I would ask that you include a copy of our 
exchange of letters on this matter in your report to accompany 
this bill. If you have questions regarding this matter, please 
do not hesitate to call me. I thank you for your consideration.
            Sincerely,
                                           John A. Boehner,
                                                          Chairman.

                                  
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