I

103D CONGRESS

1ST SESSION H. R. 2110

To amend the Public Health Service Act and title XIX of the Social Security

Act to provide for the prevention, control, and elimination of tuberculosis.

IN THE HOUSE OF REPRESENTATIVES

MAY 12, 1993

Mr. SCHUMER (for himself, Mr. TOWNS, and Mr. WAXMAN) introduced the

following bill; which was referred to the Committee on Energy and Commerce

A BILL

To amend the Public Health Service Act and title XIX

of the Social Security Act to provide for the prevention,

control, and elimination of tuberculosis.

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 ‘‘Tuberculosis Preven5 tion and Control Amendments of 1993’’.

6 SEC. 2. PROGRAMS OF CENTERS FOR DISEASE CONTROL.

7 (a) PROVISION OF SERVICES FOR PREVENTION, CON8 TROL, AND ELIMINATION.—
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1 (1) IN GENERAL.—Section 317(j)(2) of the

2 Public Health Service Act (42 U.S.C. 247b(j)(2)) is

3 amended in the first sentence—

4 (A) by striking ‘‘and’’ after ‘‘1991,’’;

5 (B) by striking ‘‘through 1995’’ and in6 serting ‘‘and 1992’’; and

7 (C) by inserting before the period the fol8 lowing: ‘‘, $300,000,000 for fiscal year 1994,

9 and such sums as may be necessary for each of

10 the fiscal years 1995 through 1998’’.

11 (2) EMERGENCY GRANTS.—

12 (A) Subject to subparagraph (B), in addi13 tion to the authorization of appropriations es14 tablished in section 317(j)(2) of the Public

15 Health Service Act for grants for the preven16 tion, control, and elimination of tuberculosis,

17 there are authorized to be appropriated for such

18 grants $85,000,000 for fiscal year 1994, and

19 such sums as may be necessary for each of the

20 fiscal years 1995 through 1998.

21 (B) Grants made pursuant to subpara22 graph (A) shall be made by the Secretary of

23 Health and Human Services, acting through the

24 Director of the Centers for Disease Control and

25 Prevention. The Secretary may make such a
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1 grant only if the geographic area in which ac2 tivities under the grant are to be carried out

3 has, relative to other areas, a substantial inci4 dence of cases of tuberculosis or a substantial

5 rate of increase in such cases.

6 (3) BULK PURCHASES.—

7 (A) Subject to subparagraph (B), in addi8 tion to the authorization of appropriations es9 tablished in section 317(j)(2) of the Public

10 Health Service Act for grants for the preven11 tion, control, and elimination of tuberculosis,

12 there are authorized to be appropriated for such

13 grants $80,000,000 for fiscal year 1994, and

14 such sums as may be necessary for each of the

15 fiscal years 1995 through 1998.

16 (B) Amounts appropriated under subpara17 graph (A) shall be administered by the Sec18 retary of Health and Human Services, acting

19 through the Director of the Centers for Disease

20 Control and Prevention. For purposes of the

21 program of grants referred to in such subpara22 graph, such amounts are available for making

23 bulk purchases of medications and other sup24 plies with respect to tuberculosis.
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1 (4) OTHER PURPOSES.—Section 317(j)(2) of

2 the Public Health Service Act (42 U.S.C.

3 247b(j)(2)) is amended by inserting after the first

4 sentence the following sentence: ‘‘The purposes for

5 which such grants under subsection (a) for such pro6 grams may be expended include services with respect

7 to incarceration.’’.

8 (b) RESEARCH, DEMONSTRATION PROJECTS, EDU9 CATION, AND TRAINING.—Section 317(k)(2) of the Public

10 Health Service Act (42 U.S.C. 247b(k)(2)) is amended—

11 (1) by redesignating subparagraphs (A) through

12 (D) as clauses (i) through (iv), respectively;

13 (2) by inserting ‘‘(A)’’ after the paragraph des14 ignation; and

15 (3) by adding at the end the following subpara16 graph:

17 ‘‘(B) For the purpose of carrying out subparagraph

18 (A), there are authorized to be appropriated $80,000,000

19 for fiscal year 1994, and such sums as may be necessary

20 for each of the fiscal years 1995 through 1998. The au21 thorization of appropriations established in the preceding

22 sentence is in addition to the authorization of appropria23 tions established in subsection (j)(2) for carrying out this

24 paragraph.’’.
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1 (c) TRAINING CENTERS REGARDING HEALTH PRO2 FESSIONALS.—

3 (1) IN GENERAL.—The Secretary of Health and

4 Human Services (in this section referred to as the

5 ‘‘Secretary’’), acting through the Director of the

6 Centers for Disease Control and Prevention, may

7 make grants to public and nonprofit private entities

8 for the establishment and operation of not more

9 than 5 centers to train health professionals with re10 spect to the prevention and control of tuberculosis,

11 including training in identifying multi-drug resistant

12 forms of such disease.

13 (2) SCREENINGS; OTHER HEALTH SERVICES.—

14 The purposes for which the Secretary may authorize

15 an entity to expend a grant under paragraph (1) in16 clude screening individuals for tuberculosis, provid17 ing treatment for such disease, and referring individ18 uals for services.

19 (3) FACILITIES AND EQUIPMENT.—The pur20 poses for which the Secretary may authorize an en21 tity to expend a grant under paragraph (1) include

22 providing for facilities and equipment for the center

23 under such paragraph.

24 (4) QUALITY OF LABORATORIES.—The Sec25 retary may make a grant under paragraph (1) only
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1 if the entity involved provides assurances satisfac2 tory to the Secretary that the laboratories of the

3 center under such paragraph will have the facilities

4 and equipment to provide sophisticated training to

5 health professionals with respect to tuberculosis.

6 (5) APPLICATION FOR GRANT.—The Secretary

7 may make a grant under paragraph (1) only if an

8 application for the grant is submitted to the Sec9 retary and the application is in such form, is made

10 in such manner, and contains such agreements, as11 surances, and information as the Secretary deter12 mines to be necessary to carry out this subsection.

13 (6) AMOUNT AND DURATION OF GRANT.—

14 (A) The Secretary may not make a grant

15 under paragraph (1) for a fiscal year in an

16 amount exceeding $5,000,000.

17 (B) The period during which payments are

18 made to an entity from a grant under para19 graph (1) may not exceed 3 years. The provi20 sion of such payments shall be subject to an21 nual approval by the Secretary of the payments

22 and subject to the availability of appropriations

23 for the fiscal year involved to make the pay24 ments.
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1 (7) EVALUATIONS; DISSEMINATION OF INFOR2 MATION.—The Secretary shall, directly or through

3 contracts with public or private entities, provide for

4 evaluations of centers operated pursuant to para5 graph (1) and for the dissemination of information

6 developed as a result of the centers.

7 (8) AUTHORIZATION OF APPROPRIATIONS.—For

8 the purpose of carrying out this subsection, there is

9 authorized to be appropriated $25,000,000 for fiscal

10 year 1994, and such sums as may be necessary for

11 each of the fiscal years 1995 through 1998.

12 SEC. 3. RESEARCH THROUGH NATIONAL INSTITUTE OF AL13 LERGY AND INFECTIOUS DISEASES.

14 (a) CERTAIN DUTIES.—

15 (1) IN GENERAL.—Subpart 6 of part C of title

16 IV of the Public Health Service Act (42 U.S.C.

17 285f) is amended by inserting after section 446 the

18 following section:

19 ‘‘RESEARCH AND RESEARCH TRAINING REGARDING

20 TUBERCULOSIS

21 ‘‘SEC. 447. In carrying out section 446, the Director

22 of the Institute shall conduct or support research and re23 search training regarding the cause, diagnosis, early detec24 tion, prevention, control, and treatment of tuberculosis.’’.

25 (2) CONFORMING AMENDMENT.—Section 446

26 of the Public Health Service Act (42 U.S.C. 285f)
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1 is amended by inserting after ‘‘Diseases’’ the follow2 ing: ‘‘(hereafter in this subpart referred to as the

3 ‘Institute’)’’.

4 (b) AUTHORIZATION OF APPROPRIATIONS.—Section

5 408(a) of the Public Health Service Act (42 U.S.C.

6 284c(a)) is amended by adding at the end the following

7 new paragraph:

8 ‘‘(3) For the purpose of carrying out section

9 447 (relating to research on tuberculosis through the

10 National Institute on Allergy and Infectious Dis11 eases), there are authorized to be appropriated

12 $50,000,000 for fiscal year 1994, and such sums as

13 may be necessary for each of the fiscal years 1995

14 through 1998. The authorization of appropriations

15 established in the preceding sentence may not be

16 construed as terminating the availability for such

17 purpose of any other authorization of appropria18 tions.’’.

19 SEC. 4. CONSTRUCTION OR MODERNIZATION OF HEALTH

20 FACILITIES.

21 Section 1610 of the Public Health Service Act (42

22 U.S.C. 300r) is amended by adding at the end the follow23 ing subsection:

24 ‘‘(c)(1) With respect to services for the prevention,

25 control, and elimination of tuberculosis, the Secretary may
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1 make grants to public and nonprofit private entities for

2 projects for (A) construction or modernization of out3 patient medical facilities which are located apart from hos4 pitals and which will provide such services for medically

5 underserved populations, (B) conversion of existing facili6 ties into outpatient medical facilities or facilities for long7 term care to provide such services for such populations,

8 (C) renovation of inpatient facilities, (D) construction or

9 renovation of facilities to provide such services with re10 spect to incarceration.

11 ‘‘(2) The amount of any grant under paragraph (1)

12 may not exceed 80 percent of the cost of the project for

13 which the grant is made unless the project is located in

14 an area determined by the Secretary to be an urban or

15 rural poverty area, in which case the grant may cover up

16 to 100 percent of such costs.

17 ‘‘(3) There are authorized to be appropriated for

18 grants under paragraph (1) $100,000,000 for fiscal year

19 1993, $250,000,000 for fiscal year 1994, and such sums

20 as may be necessary for each of the fiscal years 1995

21 through 1998.’’.
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1 SEC. 5. OPTIONAL MEDICAID COVERAGE OF TB-RELATED

2 SERVICES FOR CERTAIN TB-INFECTED INDI3 VIDUALS.

4 (a) COVERAGE AS OPTIONAL, CATEGORICALLY

5 NEEDY GROUP.—Section 1902(a)(10)(A)(ii) of the Social

6 Security Act (42 U.S.C. 1396a(a)(10)(A)(ii)) is amend7 ed—

8 (1) by striking ‘‘or’’ at the end of subclause

9 (X),

10 (2) by adding ‘‘or’’ at the end of subclause

11 (XI), and

12 (3) by adding at the end the following new

13 subclause:

14 ‘‘(XII) who are described in sub15 section (z)(1) (relating to certain TB16 infected individuals);’’.

17 (b) GROUP AND BENEFIT DESCRIBED.—Section

18 1902 of such Act is amended by adding at the end the

19 following new subsection:

20 ‘‘(z)(1) Individuals described in this paragraph are

21 individuals not described in subsection (a)(10)(A)(i)—

22 ‘‘(A) who have tested positively to be infected

23 with tuberculosis;

24 ‘‘(B) whose income (as determined under the

25 State plan under this title with respect to disabled

26 individuals) does not exceed the maximum amount
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1 of income a disabled individual described in sub2 section (a)(10)(A)(i) may have and obtain medical

3 assistance under the plan; and

4 ‘‘(C) whose resources (as determined under the

5 State plan under this title with respect to disabled

6 individuals) do not exceed the maximum amount of

7 resources a disabled individual described in sub8 section (a)(10)(A)(i) may have and obtain medical

9 assistance under the plan.

10 ‘‘(2) For purposes of subsection (a)(10), the term

11 ‘TB-related services’ means each of the following serv12 ices—

13 ‘‘(A) prescribed drugs,

14 ‘‘(B) physicians’ services and services described

15 in section 1905(a)(2),

16 ‘‘(C) laboratory and X-ray services,

17 ‘‘(D) clinic services and Federally-qualified

18 health center services, and

19 ‘‘(E) case management services (as defined in

20 section 1915(g)(2)),

21 relating to treatment of infection with tuberculosis.’’.

22 (c) LIMITATION ON BENEFITS.—Section 1902(a)(10)

23 of such Act is amended, in the matter following subpara24 graph (F)—
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1 (1) by striking ‘‘; and (XI)’’ and inserting ‘‘,

2 (XI)’’,

3 (2) by striking ‘‘, and (XI)’’ and inserting ‘‘,

4 (XII)’’, and

5 (3) by inserting before the semicolon at the end

6 the following: ‘‘, and (XIII) the medical assistance

7 made available to an individual described in sub8 section (z)(1) who is eligible for medical assistance

9 only because of subparagraph (A)(ii)(XII) shall be

10 limited to medical assistance for TB-related services

11 (described in subsection (z)(2))’’.

12 (d) CONFORMING EXPANSION OF CASE MANAGE13 MENT SERVICES OPTION.—Section 1915(g)(1) of such

14 Act (42 U.S.C. 1396n(g)(1)) is amended by inserting ‘‘or

15 to individuals described in section 1902(z)(1)(A)’’ after

16 ‘‘or with either,’’.

17 (e) CONFORMING AMENDMENT.—Section 1905(a) of

18 such Act (42 U.S.C. 1396d(a)) is amended—

19 (1) by striking ‘‘or’’ at the end of clause (ix),

20 (2) by adding ‘‘or’’ at the end of clause (x), and

21 (3) by inserting after clause (x) the following

22 new clause:

23 ‘‘(xi) individuals described in section

24 1902(z)(1),’’.
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1 (f) EFFECTIVE DATE.—The amendments made by

2 this section shall apply to medical assistance furnished on

3 or after January 1, 1994, without regard to whether or

4 not final regulations to carry out such amendments have

5 been promulgated by such date.

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