II

106TH CONGRESS

1ST SESSION S. 805

To amend title V of the Social Security Act to provide for the establishment

and operation of asthma treatment services for children, and for other

purposes.

IN THE SENATE OF THE UNITED STATES

APRIL 15, 1999

Mr. DURBIN (for himself, Mr. DEWINE, Mr. KENNEDY, and Mr. SCHUMER)

introduced the following bill; which was read twice and referred to the

Committee on Finance

A BILL

To amend title V of the Social Security Act to provide

for the establishment and operation of asthma treatment

services for children, 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 ‘‘Children’s Asthma Re5 lief Act of 1999’’.

6 SEC. 2. FINDINGS.

7 (a) FINDINGS.—Congress makes the following find8 ings:
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1 (1) Asthma is one of the Nation’s most common

2 and costly diseases. It affects an estimated

3 14,000,000 to 15,000,000 individuals in the United

4 States, including almost 5,000,000 children.

5 (2) Asthma is often a chronic illness that is

6 treatable with ambulatory care, but over 43 percent

7 of its economic impact comes from use of emergency

8 rooms, hospitalization, and death.

9 (3) In Illinois, the mortality rate for blacks

10 from asthma is the highest in the nation with 60.8

11 deaths per every 1,000,000 population. In Ohio, the

12 mortality rate for blacks from asthma is 32.2 per

13 1,000,000 population and the mortality rate for

14 whites from asthma is 11.7 per 1,000,000.

15 (4) In 1995, there were more than 1,800,000

16 emergency room visits made for asthma-related at17 tacks and among these, the rate for emergency room

18 visits was 48.8 per 10,000 visits among whites and

19 228.9 per 10,000 visits among blacks.

20 (5) Hospitalization rates were highest for indi21 viduals 4 years old and younger, and were 10.9 per

22 10,000 visits for whites and 35.5 per 10,000 visits

23 for blacks.
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1 (6) From 1979 to 1992, the hospitalization

2 rates among children due to asthma increased 74

3 percent.

4 (7) It is estimated that more than 7 percent of

5 children now have asthma.

6 (8) Although asthma can occur at any age,

7 about 80 percent of the children who will develop

8 asthma do so before starting school.

9 (9) From 1980 to 1994, the most substantial

10 prevalence rate increase for asthma occurred among

11 children aged 0–4 years (160 percent) and persons

12 aged 5–14 years (74 percent).

13 (10) Asthma is the most common chronic ill14 ness in childhood, afflicting nearly 5,000,000 chil15 dren under age 18, and costing an estimated

16 $1,900,000,000 to treat those children. The death

17 rate for children age 19 and younger increased by

18 78 percent between 1980 and 1993.

19 (11) Children aged 0 to 5 years who are ex20 posed to maternal smoking are 201 times more like21 ly to develop asthma compared with those free from

22 exposure.

23 (12) Morbidity and mortality related to child24 hood asthma are disproportionately high in urban

25 areas.
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1 (13) Minority children living in urban areas are

2 especially vulnerable to asthma. In 1988, national

3 prevalence rates were 26 percent higher for black

4 children than for white children.

5 (14) Certain pests known to create public

6 health problems occur and proliferate at higher rates

7 in urban areas. These pests may spread infectious

8 disease and contribute to the worsening of chronic

9 respiratory illnesses, including asthma.

10 (15) Research supported by the National Insti11 tutes of Health demonstrated that the combination

12 of cockroach allergen, house dust mites, molds, to13 bacco smoke, and feathers are important causes of

14 asthma-related illness and hospitalization among

15 children in inner-city areas of the United States.

16 (16) Cities outside the United States have de17 veloped and implemented effective systems of cock18 roach management.

19 (17) Integrated pest management is a cost-ef20 fective approach to pest control that emphasizes pre21 vention and uses a range of techniques, including

22 property maintenance and cleaning, and pesticides

23 as a means of last resort.

24 (18) Reducing exposure to cockroach allergen,

25 as part of an integrated approach to asthma man-
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1 agement, may be a cost-effective way of reducing the

2 social and economic costs of the disease.

3 (19) No current Federal funding exists specifi4 cally to assist cities in developing and implementing

5 integrated strategies to reduce cockroach infestation.

6 (20) Asthma is the most common cause of

7 school absenteeism due to chronic illness with

8 10,100,000 days missed from school per year in the

9 United States.

10 (21) According to a 1995 National Institute of

11 Health workshop report, missed school days ac12 counted for an estimated cost of lost productivity for

13 parents of children with asthma of almost

14 $1,000,000,000 per year.

15 (22) According to data from the 1988 National

16 Health Interview Survey (NHIS), which surveyed

17 children for their health experiences over a 12-

18 month period, 25 percent of those children reported

19 experiencing a great deal of pain or discomfort due

20 to asthma either often or all the time during the

21 previous 12 months.

22 (23) Managing asthma requires a long-term,

23 multifaceted approach, including patient education,

24 behavior changes, avoidance of asthma triggers,
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1 pharmacologic therapy, and frequent medical follow2 up.

3 (24) Enhancing the available prevention, edu4 cational, research, and treatment resources with re5 spect to asthma in the United States will allow our

6 Nation to address more effectively the problems as7 sociated with this increasing threat to the health and

8 well-being of our citizens.

9 SEC. 3. CHILDREN’S ASTHMA RELIEF.

10 Title V of the Social Security Act (42 U.S.C. 701

11 et seq.) is amended by adding at the end the following:

12 ‘‘SEC. 511. ASTHMA TREATMENT GRANTS PROGRAM.

13 ‘‘(a) PURPOSES.—The purposes of this section are as

14 follows:

15 ‘‘(1) To provide access to quality medical care

16 for children who live in areas that have a high prev17 alence of asthma and who lack access to medical

18 care.

19 ‘‘(2) To provide on-site education to parents,

20 children, health care providers, and medical teams to

21 recognize the signs and symptoms of asthma, and to

22 train them in the use of medications to prevent and

23 treat asthma.

24 ‘‘(3) To decrease preventable trips to the emer25 gency room by making medication available to indi-
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1 viduals who have not previously had access to treat2 ment or education in the prevention of asthma.

3 ‘‘(4) To provide other services, such as smoking

4 cessation programs, home modification, and other

5 direct and support services that ameliorate condi6 tions that exacerbate or induce asthma.

7 ‘‘(b) AUTHORITY TO MAKE GRANTS.—

8 ‘‘(1) IN GENERAL.—In addition to any other

9 payments made under this title, the Secretary shall

10 award grants to eligible entities to carry out the pur11 poses of this section, including grants that are de12 signed to develop and expand projects to—

13 ‘‘(A) provide comprehensive asthma serv14 ices to children, including access to care and

15 treatment for asthma in a community-based

16 setting;

17 ‘‘(B) fully equip mobile health care clinics

18 that provide preventive asthma care including

19 diagnosis, physical examinations, pharma20 cological therapy, skin testing, peak flow meter

21 testing, and other asthma-related health care

22 services;

23 ‘‘(C) conduct study validated asthma man24 agement education programs for patients with

25 asthma and their families, including patient
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1 education regarding asthma management, fam2 ily education on asthma management, and the

3 distribution of materials, including displays and

4 videos, to reinforce concepts presented by med5 ical teams; and

6 ‘‘(D) identify eligible children for the med7 icaid program under title XIX, the State Chil8 dren’s Health Insurance Program under title

9 XXI, or other children’s health programs.

10 ‘‘(2) AWARD OF GRANTS.—

11 ‘‘(A) APPLICATION.—

12 ‘‘(i) IN GENERAL.—An eligible entity

13 shall submit an application to the Sec14 retary for a grant under this section in

15 such form and manner as the Secretary

16 may require.

17 ‘‘(ii) REQUIRED INFORMATION.—An

18 application submitted under this subpara19 graph shall include a plan for the use of

20 funds awarded under the grant and such

21 other information as the Secretary may re22 quire.

23 ‘‘(B) REQUIREMENT.—In awarding grants

24 under this section, the Secretary shall give pref25 erence to eligible entities that demonstrate that
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1 the activities to be carried out under this sec2 tion shall be in localities within areas of known

3 high prevalence of childhood asthma or high

4 asthma-related mortality (relative to the aver5 age asthma incidence rates and associated mor6 tality rates in the United States). Acceptable

7 data sets to demonstrate a high prevalence of

8 childhood asthma or high asthma-related mor9 tality may include data from Federal, State, or

10 local vital statistics, title XIX or XXI claims

11 data, other public health statistics or surveys,

12 or other data that the Secretary, in consultation

13 with the Director of the Centers for Disease

14 Control and Prevention, deems appropriate.

15 ‘‘(3) DEFINITION OF ELIGIBLE ENTITY.—In

16 this section, the term ‘eligible entity’ means a State

17 agency or other entity receiving funds under this

18 title, a local community, a nonprofit children’s hos19 pital or foundation, or a nonprofit community-based

20 organization.

21 ‘‘(c) COORDINATION WITH OTHER CHILDREN’S PRO22 GRAMS.—An eligible entity shall identify in the plan sub23 mitted as part of an application for a grant under this

24 section how the entity will coordinate operations and ac25 tivities under the grant with—
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1 ‘‘(1) other programs operated in the State that

2 serve children with asthma, including any such pro3 grams operated under this title, title XIX, and title

4 XXI; and

5 ‘‘(2) one or more of the following—

6 ‘‘(A) the child welfare and foster care and

7 adoption assistance programs under parts B

8 and E of title IV;

9 ‘‘(B) the head start program established

10 under the Head Start Act (42 U.S.C. 9831 et

11 seq.);

12 ‘‘(C) the program of assistance under the

13 special supplemental nutrition program for

14 women, infants and children (WIC) under sec15 tion 17 of the Child Nutrition Act of 1966 (42

16 U.S.C. 1786);

17 ‘‘(D) local public and private elementary or

18 secondary schools; or

19 ‘‘(E) public housing agencies, as defined in

20 section 3 of the United States Housing Act of

21 1937 (42 U.S.C. 1437a).

22 ‘‘(d) EVALUATION.—An eligible entity that receives

23 a grant under this section shall submit to the Secretary

24 an evaluation of the operations and activities carried out

25 under the grant that includes—
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1 ‘‘(1) a description of the health status outcomes

2 of children assisted under the grant;

3 ‘‘(2) an assessment of the utilization of asthma4 related health care services as a result of activities

5 carried out under the grant;

6 ‘‘(3) the collection, analysis, and reporting of

7 asthma data according to guidelines prescribed by

8 the Director of the Centers for Disease Control and

9 Prevention; and

10 ‘‘(4) such other information as the Secretary

11 may require.

12 ‘‘(e) APPLICATION OF OTHER PROVISIONS OF

13 TITLE.—

14 ‘‘(1) IN GENERAL.—Except as provided in para15 graph (2), the other provisions of this title shall not

16 apply to a grant made under this section.

17 ‘‘(2) EXCEPTIONS.—The following provisions of

18 this title shall apply to a grant made under this sec19 tion to the same extent and in the same manner as

20 such provisions apply to allotments made under sec21 tion 502(c):

22 ‘‘(A) Section 504(b)(4) (relating to ex23 penditures of funds as a condition of receipt of

24 Federal funds).
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1 ‘‘(B) Section 504(b)(6) (relating to prohi2 bition on payments to excluded individuals and

3 entities).

4 ‘‘(C) Section 506 (relating to reports and

5 audits, but only to the extent determined by the

6 Secretary to be appropriate for grants made

7 under this section).

8 ‘‘(D) Section 508 (relating to non9 discrimination).

10 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There

11 are authorized to be appropriated to carry out this section

12 $50,000,000 for each of the fiscal years 2000 through

13 2004.’’.

14 SEC. 4. INCORPORATION OF ASTHMA PREVENTION TREAT15 MENT AND SERVICES INTO STATE CHIL16 DREN’S HEALTH INSURANCE PROGRAMS.

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

18 Human Services shall, in accordance with subsection (b),

19 carry out a program to encourage States to implement

20 plans to carry out activities to assist children with respect

21 to asthma in accordance with guidelines of the National

22 Asthma Education and Prevention Program (NAEPP)

23 and the National Heart, 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 child health plan under title XXI of the So3 cial Security Act (42 U.S.C. 1397aa et seq.) pro4 vides for activities described in subsection (a) to an

5 extent satisfactory to the Secretary, the Secretary

6 shall, with amounts appropriated under subsection

7 (c), make a grant to the State involved to assist the

8 State in carrying out such activities.

9 (2) CRITERIA REGARDING ELIGIBILITY FOR

10 GRANT.—The Secretary shall publish in the Federal

11 Register criteria describing the circumstances in

12 which the Secretary will consider a State plan to be

13 satisfactory for purposes of paragraph (1).

14 (3) REQUIREMENT OF MATCHING FUNDS.—

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

16 costs of the activities to be carried out by a

17 State pursuant to paragraph (1), the Secretary

18 may make a grant under such paragraph only

19 if the State agrees to make available (directly

20 or through donations from public or private en21 tities) non-Federal contributions toward such

22 costs in an amount that is not less than 15 per23 cent of the costs.

24 (B) DETERMINATION OF AMOUNT CON25 TRIBUTED.—Non-Federal contributions re-
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1 quired in subparagraph (A) may be in cash or

2 in kind, fairly evaluated, including equipment or

3 services. Amounts provided by the Federal Gov4 ernment, or services assisted or subsidized to

5 any significant extent by the Federal Govern6 ment, may not be included in determining the

7 amount of such non-Federal contributions.

8 (4) TECHNICAL ASSISTANCE.—With respect to

9 State child health plans under title XXI of the So10 cial Security Act (42 U.S.C. 1397aa et seq.), the

11 Secretary, acting through the Director of the Cen12 ters for Disease Control and Prevention, in consulta13 tion with the heads of other Federal agencies in14 volved in asthma treatment and prevention, shall

15 make available to the States technical assistance in

16 developing the provision of such plans that will pro17 vide for activities pursuant to paragraph (1).

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

19 section, there is authorized to be appropriated $5,000,000

20 for each of the fiscal years 2000 through 2004.
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1 SEC. 5. PREVENTIVE HEALTH AND HEALTH SERVICES

2 BLOCK GRANT; SYSTEMS FOR REDUCING

3 ASTHMA AND ASTHMA-RELATED ILLNESSES

4 THROUGH URBAN COCKROACH MANAGE5 MENT.

6 Section 1904(a)(1) of the Public Health Service Act

7 (42 U.S.C. 300w–3(a)(1)) is amended—

8 (1) by redesignating subparagraphs (E) and

9 (F) as subparagraphs (F) and (G), respectively;

10 (2) by adding a period at the end of subpara11 graph (G) (as so redesignated);

12 (3) by inserting after subparagraph (D), the

13 following:

14 ‘‘(E) The establishment, operation, and coordi15 nation of effective and cost-efficient systems to re16 duce the prevalence of asthma and asthma-related

17 illnesses among urban populations, especially chil18 dren, by reducing the level of exposure to cockroach

19 allergen through the use of integrated pest manage20 ment, as applied to cockroaches. Amounts expended

21 for such systems may include the costs of structural

22 rehabilitation of housing, public schools, and other

23 public facilities to reduce cockroach infestation, the

24 costs of building maintenance, and the costs of pro25 grams to promote community participation in the

26 carrying out at such sites integrated pest manage-
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1 ment, as applied to cockroaches. For purposes of

2 this subparagraph, the term ‘integrated pest man3 agement’ means an approach to the management of

4 pests in public facilities that minimizes or avoids the

5 use of pesticide chemicals through a combination of

6 appropriate practices regarding the maintenance,

7 cleaning, and monitoring of such sites.’’;

8 (4) in subparagraph (F) (as so redesignated),

9 by striking ‘‘subparagraphs (A) through (D)’’ and

10 inserting ‘‘subparagraphs (A) through (E)’’; and

11 (5) in subparagraph (G) (as so redesignated),

12 by striking ‘‘subparagraphs (A) through (E)’’ and

13 inserting ‘‘subparagraphs (A) through (F)’’.

14 SEC. 6. COORDINATION OF FEDERAL ACTIVITIES TO AD15 DRESS ASTHMA-RELATED HEALTH CARE

16 NEEDS.

17 (a) IN GENERAL.—The Director of the National

18 Heart, Lung, and Blood Institute shall, through the Na19 tional Asthma Education Prevention Program Coordi20 nating Committee—

21 (1) identify all Federal programs that carry out

22 asthma-related activities;

23 (2) develop, in consultation with appropriate

24 Federal agencies and professional and voluntary
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1 health organizations, a Federal plan for responding

2 to asthma; and

3 (3) not later than 12 months after the date of

4 enactment of this Act, submit recommendations to

5 Congress on ways to strengthen and improve the co6 ordination of asthma-related activities of the Federal

7 Government.

8 (b) REPRESENTATION OF THE DEPARTMENT OF

9 HOUSING AND URBAN DEVELOPMENT.—A representative

10 of the Department of Housing and Urban Development

11 shall be included on the National Asthma Education Pre12 vention Program Coordinating Committee for the purpose

13 of performing the tasks described in subsection (a).

14 (c) AUTHORIZATION OF APPROPRIATIONS.—Out of

15 any funds otherwise appropriated for the National Insti16 tutes of Health, $5,000,000 shall be made available to the

17 National Asthma Education Prevention Program for the

18 period of fiscal years 2000 through 2004 for the purpose

19 of carrying out this section. Funds made available under

20 this subsection shall be in addition to any other funds ap21 propriated to the National Asthma Education Prevention

22 Program for any fiscal year during such period.
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1 SEC. 7. COMPILATION OF DATA BY THE CENTERS FOR DIS2 EASE CONTROL AND PREVENTION.

3 (a) IN GENERAL.—The Director of the Centers for

4 Disease Control and Prevention, in consultation with the

5 National Asthma Education Prevention Program Coordi6 nating Committee, shall—

7 (1) conduct local asthma surveillance activities

8 to collect data on the prevalence and severity of

9 asthma and the quality of asthma management,

10 including—

11 (A) telephone surveys to collect sample

12 household data on the local burden of asthma;

13 and

14 (B) health care facility specific surveillance

15 to collect asthma data on the prevalence and se16 verity of asthma, and on the quality of asthma

17 care; and

18 (2) compile and annually publish data on—

19 (A) the prevalence of children suffering

20 from asthma in each State; and

21 (B) the childhood mortality rate associated

22 with asthma nationally and in each State.

23 (b) COLLABORATIVE EFFORTS.—The activities de24 scribed in subsection (a)(1) may be conducted in collabo-
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1 ration with eligible entities awarded a grant under section

2 511 of the Social Security Act (as added by section 3).

Æ