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[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[S. 1249 Introduced in Senate (IS)]

103d CONGRESS
  1st Session
                                S. 1249

 To amend the Public Health Service Act to provide for the prevention, 
   control, and elimination of tuberculosis, and for other purposes.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                July 15 (legislative day, June 30), 1993

Mr. Kennedy (for himself, Mrs. Kassebaum, Mr. Metzenbaum, Mr. Jeffords, 
Mr. Hatch, Mr. Wofford, Mr. Durenberger, Mr. Wellstone, and Mr. Simon) 
introduced the following bill; which was read twice and referred to the 
                 Committee on Labor and Human Resources

_______________________________________________________________________

                                 A BILL

 
 To amend the Public Health Service Act to provide for the prevention, 
   control, and elimination of tuberculosis, 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 ``Tuberculosis Prevention and Control 
Amendments of 1993''.

SEC. 2. FINDINGS.

    Congress finds that--
            (1) between 10,000,000 and 15,000,000 people in the United 
        States have been infected with tuberculosis, nearly 26,000 new 
        active cases are reported each year, and over 1,700 
        tuberculosis-related deaths occur each year;
            (2) the number of reported cases of tuberculosis has risen 
        from 22,201 in 1985 to 26,673 in 1992, representing 51,000 more 
        cases than those that would have been expected since 1985;
            (3) a recent national survey discovered that 14.4 percent 
        of all active tuberculosis cases were resistant to at least one 
        drug;
            (4) drug resistant tuberculosis strains can cost more than 
        $150,000 to treat, and even then, between 40 and 60 percent of 
        the patients receiving such treatment die;
            (5) in 1992, tuberculosis cases were reported to the 
        Centers for Disease Control and Prevention by all 50 States, 
        and cases resistant to one or more tuberculosis drugs were 
        reported in at least 36 States, the District of Columbia and 
        Puerto Rico;
            (6) in 1992, 27 percent of the reported cases of 
        tuberculosis occurred in foreign born persons;
            (7) one third of the world's population harbors 
        tuberculosis; and
            (8) among infectious diseases tuberculosis is still the 
        number one killer in the world with an estimated 8,000,000 new 
        cases each year and 2,900,000 deaths.

SEC. 3. PROGRAMS OF CENTERS FOR DISEASE CONTROL AND PREVENTION.

    (a) Provision of Services for Prevention, Control, and 
Elimination.--Section 317(j)(2) of the Public Health Service Act (42 
U.S.C. 247b(j)(2)) is amended in the first sentence by striking ``and'' 
after ``1991,'' and all that follows through ``1995'' and inserting the 
following: ``, $104,000,000 for fiscal year 1994, and such sums as may 
be necessary for each of the fiscal years 1995 through 1997''.
    (b) State Tuberculosis Plan.--Section 317(j) of the Public Health 
Service Act (42 U.S.C. 247b(j)) is amended by adding at the end thereof 
the following new paragraph:
    ``(3)(A) With respect to an application submitted by a State for a 
grant under this section for the prevention, control and elimination of 
tuberculosis, such application shall contain a State plan that 
demonstrates that amounts received under the grant will be expended in 
a manner that ensures that tuberculosis services will be provided to 
those at the highest risk of contracting tuberculosis, or in those 
areas with the highest rates of tuberculosis infection.
    ``(B) Such plans shall demonstrate that the applicant will work 
closely with and provide support to entities receiving funds under 
sections 329, 330, 340, 340A, or titles V or XIX, and to correctional 
facilities, and nongovernmental organizations such as community-based 
organizations.
    ``(C) Such plans shall demonstrate that grant funds will be used 
for directly observed therapy or other effective interventions with 
respect to populations with the highest rates of active infection with 
tuberculosis.''.
    (c) Research, Demonstration Projects, Education, and Training.--
            (1) In general.--Section 317(k)(2) of the Public Health 
        Service Act (42 U.S.C. 247b(k)(2)) is amended--
                    (A) by redesignating subparagraphs (A) through (D) 
                as clauses (i) through (iv), respectively;
                    (B) by inserting ``(A)'' after the paragraph 
                designation; and
                    (C) by adding at the end thereof the following new 
                subparagraphs:
    ``(B) In support of grants referred to in subparagraph (A), the 
Secretary may conduct or support applied research and training 
regarding the surveillance, diagnostic methodologies, prevention, 
control, and treatment of tuberculosis, including intramural projects 
and extramural projects.
    ``(C) For the purpose of carrying out subparagraph (A), there are 
authorized to be appropriated $26,000,000 for fiscal year 1994, and 
such sums as may be necessary for each of the fiscal years 1995 through 
1997. The authorization of appropriations established in the preceding 
sentence is in addition to the authorization of appropriations 
established in subsection (j)(2) for carrying out this paragraph.''.
            (2) Technical amendment.--Section 317(j)(2) of the Public 
        Health Service Act (42 U.S.C. 247b(j)(2)) is amended by 
        striking the last sentence.

SEC. 4. RESEARCH THROUGH NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS 
              DISEASES.

    (a) Certain Duties.--
            (1) In general.--Subpart 6 of part C of title IV of the 
        Public Health Service Act (42 U.S.C. 285f) is amended by 
        inserting after section 446 the following section:

        ``research and research training regarding tuberculosis

    ``Sec. 447. In carrying out section 446, the Director of the 
Institute shall conduct or support basic research and research training 
regarding the cause, diagnosis, early detection and treatment of 
tuberculosis.''.
            (2) Conforming amendment.--Section 446 of the Public Health 
        Service Act (42 U.S.C. 285f) is amended by inserting after 
        ``Diseases'' the following: ``(hereafter in this subpart 
        referred to as the `Institute')''.
    (b) Authorization of Appropriations.--Section 408(a) of the Public 
Health Service Act (42 U.S.C. 284c(a)) is amended by adding at the end 
the following new paragraph:
            ``(3) For the purpose of carrying out section 447 (relating 
        to research on tuberculosis through the National Institute on 
        Allergy and Infectious Diseases), there are authorized to be 
        appropriated $46,000,000 for fiscal year 1994, and such sums as 
        may be necessary for each of the fiscal years 1995 through 
        1997. The authorization of appropriations established in the 
        preceding sentence may not be construed as terminating the 
        availability for such purpose of any other authorization of 
        appropriations.''.

SEC. 5. RESEARCH THROUGH THE FOOD AND DRUG ADMINISTRATION.

    Chapter V of the Food, Drug and Cosmetic Act is amended by 
inserting after section 512 (21 U.S.C. 360b) the following new section:

``SEC. 512A. TUBERCULOSIS DRUG AND DEVICE RESEARCH.

    ``(a) Authority.--The Commissioner of Food and Drugs shall 
implement a tuberculosis drug and device research program under which 
the Commissioner shall--
            ``(1) provide assistance to other Federal agencies for the 
        development of tuberculosis protocols;
            ``(2) review and evaluate medical devices designed for the 
        diagnosis and control of airborne tuberculosis; and
            ``(3) conduct research concerning drugs or devices to be 
        used in diagnosing, controlling and preventing tuberculosis.
    ``(b) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section, $5,000,000 for each fiscal 
year.''.

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