I

106TH CONGRESS

1ST SESSION H. R. 1965

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 26, 1999

Mrs. LOWEY (for herself and Mr. BARTON of Texas) introduced the following

bill; which was referred to the Committee on 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’’.

5 SEC. 2. FINDINGS.

6 The Congress finds as follows:
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1 (1) Despite improved therapies, the prevalence

2 rate of asthma continues to rise, affecting an esti3 mated 14.6 million Americans; 4.4 million under the

4 age of 18. Since 1982, the prevalence of pediatric

5 asthma has risen 76 percent. Rates are increasing

6 for all ethnic groups and especially for African

7 American and Hispanic children.

8 (2) Asthma is the third leading cause of pre9 ventable hospitalizations. Improper diagnosis and

10 poor management of asthma resulted in 1.6 million

11 people being treated for asthma attacks in the emer12 gency room in 1995.

13 (3) Asthma can be life-threatening if not prop14 erly managed. Most asthma-related deaths are pre15 ventable, yet such deaths continue to rise in the U.S.

16 In 1996, 5,667 individuals died as a result of an

17 asthma attack, nearly double the number of deaths

18 in 1980.

19 (4) The costs of asthma to the U.S. was over

20 $6 billion in 1990, 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 2000 through 2004. 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,

11 including—

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 2000 through

5 2004.

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 2000 through 2004.

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 2000 through 2004.

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 2000 through 2004.

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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