39–010 

Calendar No. 784 

108TH CONGRESS REPORT " ! SENATE 2d Session 108–394 

ASTHMATIC SCHOOLCHILDREN’S TREATMENT AND 

HEALTH MANAGEMENT ACT OF 2004 

OCTOBER 8, 2004.—Ordered to be printed 

Mr. GREGG, from the Committee on Health, Education, Labor, and 

Pensions, submitted the following 

R E P O R T 

[To accompany S. 2815] 

The Committee on Health, Education, Labor, and Pensions, to 

which was referred the bill (S. 2815) to give 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, reports favorably 

thereon without an amendment and recommends that the bill do 

pass. 

CONTENTS 

Page 

I. Purpose and need for legislation .................................................................. 1 

II. Summary ........................................................................................................ 2 

III. History of legislation and votes in committee ............................................. 3 

IV. Explanation of bill and committee views ..................................................... 4 

V. Cost estimate .................................................................................................. 4 

VI. Regulatory impact statement ........................................................................ 5 

VII. Application of law to the legislative branch ................................................ 5 

VIII. Section-by-section analysis ............................................................................ 5 

IX. Changes in existing law ................................................................................ 6 

I. PURPOSE AND NEED FOR LEGISLATION

According to reports of the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH), of 20 

million Americans with asthma, 6.3 million are children under 18 

years of age. This chronic condition is the cause of 728,000 emergency room visits, 214,000 hospitalizations and 223 deaths annually among children. It also accounts for 14 million missed schools 

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days each year. The CDC reports indicate that working parents of 

children with asthma lose an estimated 1 billion dollars in productivity annually. Unfortunately, the number of persons with asthma 

has doubled in the United States during the past 15 years. 

Consistent with the goals of the Healthy People 2010, the CDCdirected National Asthma Program is based on three public health 

strategies; (1) tracking, collecting and analyzing data on an ongoing 

basis to understand the ‘‘who, what, and where’’ of asthma; (2) 

interventions including translation of scientific information into 

public health practices to reduce the burden of asthma including 

school based strategies for children, and (3) partnerships with 

stakeholders in developing, implementing and evaluating local 

asthma control programs. The CDC recommends development of 

asthma friendly school environments designed to help students 

manage their asthma through a coordinated approach. 

The National Asthma Education and Prevention Program, coordinated by the National Heart, Lung and Blood Institute, published 

a resolution recommending that schools adopt policies for the management of asthma that encourage the active participation of students in the self-management of their condition and allow for the 

most consistent, active participation in all school activities. In 

2002, a committee of experts organized by Rand Corporation for 

improving childhood asthma outcomes also recommended that the 

Secretary of the Health and Human Services (HHS) consider giving 

states incentives to adopt policies that address the needs of children with asthma. 

Schools should be a safe place where children learn and play; 

that should be true for children with asthma also. Thirty-one states 

have laws protecting the rights of asthmatic children to carry and 

self-administer metered-dose inhalers. Nineteen states expand this 

protection to include auto-injectable epinephrine. Furthermore, additional states have pending legislation to allow children to carry 

their inhalers and anaphylaxis medication at school. Experts, including the NIH and CDC report that self-administration of asthma medication reduces unnecessary emergency room visits, reduces 

missed school days, promotes participation in school activities and 

even saves lives. However, many schools do not allow and many 

states do not require schools to allow students to manage their 

asthma during school hours. The goal of this legislation is to build 

on the successful momentum that many states are currently experiencing in implementing comprehensive and effective asthma-related programs in schools. 

II. SUMMARY

The bill, as passed by the committee, requires that the Secretary 

of Health and Human Services, in making any grant to States that 

is asthma-related, shall give preference to any State with statutory 

or regulatory provisions described in the proposed bill. The State 

must require each public elementary and secondary school to grant 

an authorization for self-administration of asthma medication if the 

student has demonstrated the skill level necessary to use the asthma medication and any device that is necessary to administer the 

medication. The State must also require schools to grant an authorization for self- administration of the asthma medication in accordance with a written treatment plan prescribed by the health care 

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practitioner with documentation from parents. The authorization 

granted to asthmatic children to possess and use medications must 

extend to any school sponsored activity such as before-school and 

after-school activities, and transit to and from school and schoolsponsored activities. The plan must be renewed annually and the 

back up medication, if provided by parents or guardians, must be 

kept at a student’s school in a location easily accessible to the student in event of an emergency. 

The grant preferences are to apply to public-health-oriented, 

asthma-related grants to States generally awarded by the CDC. 

The bill gives the Secretary the discretion to determine which asthma-related grants to States would receive preference described in 

the Act. NIH grants to researchers or grants from other agencies 

to health care institutions for basic and clinical research, or diagnostic and therapeutic innovation, surveillance and epidemiology, 

and community approaches by health care institutions to achieve 

reduction in asthma-related morbidity and mortality are not made 

through States and will not be affected by this bill. The committee 

does not intend for this legislation to have an adverse funding impact on current grants and continuation funding of those grants 

solely due to a lack of statutory or regulatory provisions described 

in this legislation. 

The bill includes a rule of construction that states that nothing 

in the subsection creates a cause of action or in any other way increases or diminishes the liability of any person under the law. The 

purpose of this rule is to address concerns of school administrators 

about potential increase in their liability, for example from errors 

in self-administration of drugs by asthmatic children that may result from the provisions of this bill. 

The amendment made by this statute shall apply to grants made 

on or after the date that is 9 months after the date of the enactment of this Act. This will allow time for any State that currently 

does not have appropriate statutes or regulations in place to make 

necessary changes in their statutes. The committee anticipates that 

9 months is sufficient time for any State to put in place provisions 

necessary to meet the conditions of the Act. 

The bill expresses the sense of the Senate in commending the 

CDC for creating strategies for addressing asthma in a coordinated 

school program and encourages all schools to review the CDC recommendations and adopt the policies that best meet their students’

needs. 

III. HISTORY OF LEGISLATION AND VOTES IN COMMITTEE

On July 14, 2004, the House Committee on Energy and Commerce, reported favorably a bill (H.R. 2023) to give preferences to 

states that require schools to allow students to self-administer 

medication to treat their asthma or anaphylaxis. On September 20, 

2004, Senator DeWine (for himself) and Senators Corzine, Durbin 

and Kennedy introduced S.2815, which is identical to H.R.2023 as 

passed by the House committee. The committee passed the bill 

(S.2815) by unanimous consent on September 22, 2004. 

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IV. EXPLANATION OF THE BILL AND COMMITTEE VIEWS

The committee intends to ensure that asthmatic children are 

able to remain healthy, attend schools and participate in learning 

and play activities. To achieve these goals, they should be able to 

take the medications prescribed by their health care providers. 

Schools should be aware of the management plan prescribed by the 

child’s physician and keep the back-up medication where the child 

can have access to it in the event of emergency. 

The bill, as passed by the committee, will build on the successful 

momentum that many States are currently experiencing in developing asthma-related programs in schools. Federal asthma-related 

grants will be awarded by the Secretary to assist these States in 

continuing to develop effective asthma-related programs in the 

school system. Preference for those grants will go to States with 

demonstrated, comprehensive, and effective asthma programs-including provisions regarding self-medication in schools. The committee notes that this legislation does not affect whether States 

pass laws that require schools to allow self-medication for diseases 

and health conditions other than asthma and anaphylaxis. 

V. COST ESTIMATE

U.S. CONGRESS, 

CONGRESSIONAL BUDGET OFFICE, 

Washington, DC, September 27, 2004. 

Hon. JUDD GREGG, 

Chairman, Committee on Health, Education, Labor and Pensions, 

U.S. Senate, Washington, DC. 

DEAR MR. CHAIRMAN: The Congressional Budget Office has prepared the enclosed cost estimate for S. 2815, 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 contacts are Tim Gronniger (for 

federal costs), and Leo Lex (for the state and local impact). 

Sincerely, 

ELIZABETH ROBINSON

(For Douglas Holtz-Eakin, Director). 

Enclosure. 

S. 2815—Asthmatic Schoolchildren’s Treatment and Health Management Act of 2004 

S. 2815 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 S. 2815 

would not have a significant effect on the federal budget. Enacting 

S. 2815 would not affect direct spending or revenues. 

S. 2815 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 

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states who allow schoolchildren to self-administer asthma medication. While the bill would not alter the total amount of grants 

available, the new preference 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. 

VI. REGULATORY IMPACT STATEMENT

The committee has determined that there will be de minimus 

changes in the regulatory burden imposed by the bill. 

VII. APPLICATION OF LAW TO THE LEGISLATIVE BRANCH

Section 102(b)(3) of Public Law 104–1, the Congressional Accountability Act (CAA) requires a description of the application of 

this bill to the legislative branch. This bill does not amend any act 

that applies to the legislative branch. 

VIII. SECTION-BY-SECTION ANALYSIS

Section 1. Short title 

The short title of the Act is ‘‘Asthmatic School Children’s Treatment and Health Management Act of 2004’’. 

Section 2. Findings 

The Section 2 reviews the findings of the Congress with respect 

to prevalence of asthma, and the impact of this chronic disease on 

the use of health care facilities, attendance at schools, and costs. 

The section reviews the current status of regulation in states and 

problems encountered by children who attend schools that do not 

allow self-management of asthma. These problems, in addition to 

missed school days, include many instances of illness, emergency 

room visits, hospitalization, and death. The section provides a rationale for the bill. 

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

Section 399L of the Public Health Service Act (42 U.S.C. 280g) 

is amended by redesignating subsection (d) as subsection (e) and 

inserting after the subsection (c) a subsection (d) to include the following. 

The Secretary, in awarding 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 specific 

criteria. The State must require each public elementary and secondary school to grant an authorization for self-administration of 

asthma medication in accordance with a written treatment plan 

prescribed by the health care practitioner with documentation from 

parents including documents related to liability. The authorization 

extends to any school sponsored activity such as before-school and 

after-school activities. The plan must be renewed annually and the 

back up medication, if provided by parents or guardians, must be 

kept at a student’s school in a location easily accessible to the stuVerDate Aug 04 2004 07:39 Oct 16, 2004 Jkt 039010 PO 00000 Frm 00005 Fmt 6659 Sfmt 6602 E:\HR\OC\SR394.XXX SR394
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dent in event of an emergency. The authorization must be effective 

only for the same school and the same year for which it is granted 

and renewed by the parent or guardian each subsequent school 

year. 

The section will be applicable after 9 months from the date of enactment to allow States to pass appropriate legislation. 

Section 4. Sense of Congress commending CDC for its strategies for 

addressing asthma within a coordinated school health programs 

The section commends the CDC for identifying and creating 

strategies for addressing asthma with a coordinated school program for schools to address asthma and encourages all schools to 

review these policies to meet the needs of their student population. 

IX. CHANGES IN EXISTING LAW

In compliance with rule XXVI paragraph 12 of the Standing 

Rules of the Senate, the following provides a print of the statute 

or the part or section thereof to be amended or replaced (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): 

PUBLIC HEALTH SERVICE ACT 

* * * * * * * 

PART P—ADDITIONAL PROGRAMS 

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

(a) AUTHORITY TO MAKE GRANTS.—

(1) IN GENERAL.—* * * 

* * * * * * * 

(d) PREFERENCE FOR STATES THAT ALLOW STUDENTS TO SELFADMINISTER MEDICATION TO TREAT ASTHMA AND ANAPHYLAXIS.—

(1) PREFERENCE.—The Secretary, in awarding 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; 

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(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 fro 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 clauses (iii) and (iv) of 

subparagraph (A) 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) ELEMENTARY SCHOOL AND SECONDARY SCHOOL.—The 

terms ‘elementary school’ and ‘secondary school’ have the 

meanings given to those terms in section 9101 of the Elementary and Secondary Education Act of 1965. 

(B) HEALTH CARE PRACTITIONER.—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) MEDICATION.—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) SELF-ADMINISTRATION.—The term ‘self-administration’ means a student’s discretionary use of his or her prescribed asthma or anaphylaxis medication, pursuant to a 

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prescription or written direction from a health care practitioner. 

* * * * * * * 

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