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[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2110 Introduced in House (IH)]

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.

    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. PROGRAMS OF CENTERS FOR DISEASE CONTROL.

    (a) Provision of Services for Prevention, Control, and 
Elimination.--
            (1) In general.--Section 317(j)(2) of the Public Health 
        Service Act (42 U.S.C. 247b(j)(2)) is amended in the first 
        sentence--
                    (A) by striking ``and'' after ``1991,'';
                    (B) by striking ``through 1995'' and inserting 
                ``and 1992''; and
                    (C) by inserting before the period the following: 
                ``, $300,000,000 for fiscal year 1994, and such sums as 
                may be necessary for each of the fiscal years 1995 
                through 1998''.
            (2) Emergency grants.--
                    (A) Subject to subparagraph (B), in addition to the 
                authorization of appropriations established in section 
                317(j)(2) of the Public Health Service Act for grants 
                for the prevention, control, and elimination of 
                tuberculosis, there are authorized to be appropriated 
                for such grants $85,000,000 for fiscal year 1994, and 
                such sums as may be necessary for each of the fiscal 
                years 1995 through 1998.
                    (B) Grants made pursuant to subparagraph (A) shall 
                be made by the Secretary of Health and Human Services, 
                acting through the Director of the Centers for Disease 
                Control and Prevention. The Secretary may make such a 
                grant only if the geographic area in which activities 
                under the grant are to be carried out has, relative to 
                other areas, a substantial incidence of cases of 
                tuberculosis or a substantial rate of increase in such 
                cases.
            (3) Bulk purchases.--
                    (A) Subject to subparagraph (B), in addition to the 
                authorization of appropriations established in section 
                317(j)(2) of the Public Health Service Act for grants 
                for the prevention, control, and elimination of 
                tuberculosis, there are authorized to be appropriated 
                for such grants $80,000,000 for fiscal year 1994, and 
                such sums as may be necessary for each of the fiscal 
                years 1995 through 1998.
                    (B) Amounts appropriated under subparagraph (A) 
                shall be administered by the Secretary of Health and 
                Human Services, acting through the Director of the 
                Centers for Disease Control and Prevention. For 
                purposes of the program of grants referred to in such 
                subparagraph, such amounts are available for making 
                bulk purchases of medications and other supplies with 
                respect to tuberculosis.
            (4) Other purposes.--Section 317(j)(2) of the Public Health 
        Service Act (42 U.S.C. 247b(j)(2)) is amended by inserting 
        after the first sentence the following sentence: ``The purposes 
        for which such grants under subsection (a) for such programs 
        may be expended include services with respect to 
        incarceration.''.
    (b) Research, Demonstration Projects, Education, and Training.--
Section 317(k)(2) of the Public Health Service Act (42 U.S.C. 
247b(k)(2)) is amended--
            (1) by redesignating subparagraphs (A) through (D) as 
        clauses (i) through (iv), respectively;
            (2) by inserting ``(A)'' after the paragraph designation; 
        and
            (3) by adding at the end the following subparagraph:
    ``(B) For the purpose of carrying out subparagraph (A), there are 
authorized to be appropriated $80,000,000 for fiscal year 1994, and 
such sums as may be necessary for each of the fiscal years 1995 through 
1998. 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.''.
    (c) Training Centers Regarding Health Professionals.--
            (1) In general.--The Secretary of Health and Human Services 
        (in this section referred to as the ``Secretary''), acting 
        through the Director of the Centers for Disease Control and 
        Prevention, may make grants to public and nonprofit private 
        entities for the establishment and operation of not more than 5 
        centers to train health professionals with respect to the 
        prevention and control of tuberculosis, including training in 
        identifying multi-drug resistant forms of such disease.
            (2) Screenings; other health services.--The purposes for 
        which the Secretary may authorize an entity to expend a grant 
        under paragraph (1) include screening individuals for 
        tuberculosis, providing treatment for such disease, and 
        referring individuals for services.
            (3) Facilities and equipment.--The purposes for which the 
        Secretary may authorize an entity to expend a grant under 
        paragraph (1) include providing for facilities and equipment 
        for the center under such paragraph.
            (4) Quality of laboratories.--The Secretary may make a 
        grant under paragraph (1) only if the entity involved provides 
        assurances satisfactory to the Secretary that the laboratories 
        of the center under such paragraph will have the facilities and 
        equipment to provide sophisticated training to health 
        professionals with respect to tuberculosis.
            (5) Application for grant.--The Secretary may make a grant 
        under paragraph (1) only if an application for the grant is 
        submitted to the Secretary and the application is in such form, 
        is made in such manner, and contains such agreements, 
        assurances, and information as the Secretary determines to be 
        necessary to carry out this subsection.
            (6) Amount and duration of grant.--
                    (A) The Secretary may not make a grant under 
                paragraph (1) for a fiscal year in an amount exceeding 
                $5,000,000.
                    (B) The period during which payments are made to an 
                entity from a grant under paragraph (1) may not exceed 
                3 years. The provision of such payments shall be 
                subject to annual approval by the Secretary of the 
                payments and subject to the availability of 
                appropriations for the fiscal year involved to make the 
                payments.
            (7) Evaluations; dissemination of information.--The 
        Secretary shall, directly or through contracts with public or 
        private entities, provide for evaluations of centers operated 
        pursuant to paragraph (1) and for the dissemination of 
        information developed as a result of the centers.
            (8) Authorization of appropriations.--For the purpose of 
        carrying out this subsection, there is authorized to be 
        appropriated $25,000,000 for fiscal year 1994, and such sums as 
        may be necessary for each of the fiscal years 1995 through 
        1998.

SEC. 3. 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 research and research training 
regarding the cause, diagnosis, early detection, prevention, control, 
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 $50,000,000 for fiscal year 1994, and such sums as 
        may be necessary for each of the fiscal years 1995 through 
        1998. 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. 4. CONSTRUCTION OR MODERNIZATION OF HEALTH FACILITIES.

    Section 1610 of the Public Health Service Act (42 U.S.C. 300r) is 
amended by adding at the end the following subsection:
    ``(c)(1) With respect to services for the prevention, control, and 
elimination of tuberculosis, the Secretary may make grants to public 
and nonprofit private entities for projects for (A) construction or 
modernization of outpatient medical facilities which are located apart 
from hospitals and which will provide such services for medically 
underserved populations, (B) conversion of existing facilities into 
outpatient medical facilities or facilities for long-term care to 
provide such services for such populations, (C) renovation of inpatient 
facilities, (D) construction or renovation of facilities to provide 
such services with respect to incarceration.
    ``(2) The amount of any grant under paragraph (1) may not exceed 80 
percent of the cost of the project for which the grant is made unless 
the project is located in an area determined by the Secretary to be an 
urban or rural poverty area, in which case the grant may cover up to 
100 percent of such costs.
    ``(3) There are authorized to be appropriated for grants under 
paragraph (1) $100,000,000 for fiscal year 1993, $250,000,000 for 
fiscal year 1994, and such sums as may be necessary for each of the 
fiscal years 1995 through 1998.''.

SEC. 5. OPTIONAL MEDICAID COVERAGE OF TB-RELATED SERVICES FOR CERTAIN 
              TB-INFECTED INDIVIDUALS.

    (a) Coverage as Optional, Categorically Needy Group.--Section 
1902(a)(10)(A)(ii) of the Social Security Act (42 U.S.C. 
1396a(a)(10)(A)(ii)) is amended--
            (1) by striking ``or'' at the end of subclause (X),
            (2) by adding ``or'' at the end of subclause (XI), and
            (3) by adding at the end the following new subclause:
                                    ``(XII) who are described in 
                                subsection (z)(1) (relating to certain 
                                TB-infected individuals);''.
    (b) Group and Benefit Described.--Section 1902 of such Act is 
amended by adding at the end the following new subsection:
    ``(z)(1) Individuals described in this paragraph are individuals 
not described in subsection (a)(10)(A)(i)--
            ``(A) who have tested positively to be infected with 
        tuberculosis;
            ``(B) whose income (as determined under the State plan 
        under this title with respect to disabled individuals) does not 
        exceed the maximum amount of income a disabled individual 
        described in subsection (a)(10)(A)(i) may have and obtain 
        medical assistance under the plan; and
            ``(C) whose resources (as determined under the State plan 
        under this title with respect to disabled individuals) do not 
        exceed the maximum amount of resources a disabled individual 
        described in subsection (a)(10)(A)(i) may have and obtain 
        medical assistance under the plan.
    ``(2) For purposes of subsection (a)(10), the term `TB-related 
services' means each of the following services--
            ``(A) prescribed drugs,
            ``(B) physicians' services and services described in 
        section 1905(a)(2),
            ``(C) laboratory and X-ray services,
            ``(D) clinic services and Federally-qualified health center 
        services, and
            ``(E) case management services (as defined in section 
        1915(g)(2)),
relating to treatment of infection with tuberculosis.''.
    (c) Limitation on Benefits.--Section 1902(a)(10) of such Act is 
amended, in the matter following subparagraph (F)--
            (1) by striking ``; and (XI)'' and inserting ``, (XI)'',
            (2) by striking ``, and (XI)'' and inserting ``, (XII)'', 
        and
            (3) by inserting before the semicolon at the end the 
        following: ``, and (XIII) the medical assistance made available 
        to an individual described in subsection (z)(1) who is eligible 
        for medical assistance only because of subparagraph 
        (A)(ii)(XII) shall be limited to medical assistance for TB-
        related services (described in subsection (z)(2))''.
    (d) Conforming Expansion of Case Management Services Option.--
Section 1915(g)(1) of such Act (42 U.S.C. 1396n(g)(1)) is amended by 
inserting ``or to individuals described in section 1902(z)(1)(A)'' 
after ``or with either,''.
    (e) Conforming Amendment.--Section 1905(a) of such Act (42 U.S.C. 
1396d(a)) is amended--
            (1) by striking ``or'' at the end of clause (ix),
            (2) by adding ``or'' at the end of clause (x), and
            (3) by inserting after clause (x) the following new clause:
            ``(xi) individuals described in section 1902(z)(1),''.
    (f) Effective Date.--The amendments made by this section shall 
apply to medical assistance furnished on or after January 1, 1994, 
without regard to whether or not final regulations to carry out such 
amendments have been promulgated by such date.

                                 <all>
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