I
106TH CONGRESS
1ST SESSION
H. R. 2840
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 HOUSE OF REPRESENTATIVES
SEPTEMBER 13, 1999
Mr. UPTON (for himself and Mr. WAXMAN) introduced the following bill;
which was referred to the Committee on Commerce
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.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Children’s Asthma Re-
lief Act of 1999’’.
SEC. 2. FINDINGS.
(a) FINDINGS.—Congress makes the following find-
ings:
(1) Asthma is one of the Nation’s most common
and costly diseases. It affects an estimated
14,000,000 to 15,000,000 individuals in the United
States, including almost 5,000,000 children.
(2) Asthma is often a chronic illness that is
treatable with ambulatory care, but over 43 percent
of its economic impact comes from use of emergency
rooms, hospitalization, and death.
(3) In 1995, there were more than 1,800,000
emergency room visits made for asthma-related at-
tacks and among these, the rate for emergency room
visits was 48.8 per 10,000 visits among whites and
228.9 per 10,000 visits among blacks.
(4) Hospitalization rates were highest for indi-
viduals 4 years old and younger, and were 10.9 per
10,000 visits for whites and 35.5 per 10,000 visits
for blacks.
(5) From 1979 to 1992, the hospitalization
rates among children due to asthma increased 74
percent.
(6) It is estimated that more than 7 percent of
children now have asthma.
(7) Although asthma can occur at any age,
about 80 percent of the children who will develop
asthma do so before starting school.
(8) From 1980 to 1994, the most substantial
prevalence rate increase for asthma occurred among
children aged 0–4 years (160 percent) and persons
aged 5–14 years (74 percent).
(9) Asthma is the most common chronic illness
in childhood, afflicting nearly 5,000,000 children
under 
age 
18, 
and 
costing 
an 
estimated
$1,900,000,000 to treat those children. The death
rate for children age 19 and younger increased by
78 percent between 1980 and 1993.
(10) Children aged 0 to 5 years who are ex-
posed to maternal smoking are 201 times more like-
ly to develop asthma compared with those free from
exposure.
(11) Morbidity and mortality related to child-
hood asthma are disproportionately high in urban
areas.
(12) Minority children living in urban areas are
especially vulnerable to asthma. In 1988, national
prevalence rates were 26 percent higher for black
children than for white children.
(13) Certain pests known to create public
health problems occur and proliferate at higher rates
in urban areas. These pests may spread infectious
disease and contribute to the worsening of chronic
respiratory illnesses, including asthma.
(14) Research supported by the National Insti-
tutes of Health demonstrated that the combination
of cockroach allergen, house dust mites, molds, to-
bacco smoke, and feathers are important causes of
asthma-related illness and hospitalization among
children in inner-city areas of the United States.
(15) Cities outside the United States have de-
veloped and implemented effective systems of cock-
roach management.
(16) Integrated pest management is a cost-ef-
fective approach to pest control that emphasizes pre-
vention and uses a range of techniques, including
property maintenance and cleaning, and pesticides
as a means of last resort.
(17) Reducing exposure to cockroach allergen,
as part of an integrated approach to asthma man-
agement, may be a cost-effective way of reducing the
social and economic costs of the disease.
(18) No current Federal funding exists specifi-
cally to assist cities in developing and implementing
integrated strategies to reduce cockroach infestation.
(19) Asthma is the most common cause of
school absenteeism due to chronic illness with
10,100,000 days missed from school per year in the
United States.
(20) According to a 1995 National Institute of
Health workshop report, missed school days ac-
counted for an estimated cost of lost productivity for
parents 
of 
children 
with 
asthma 
of 
almost
$1,000,000,000 per year.
(21) According to data from the 1988 National
Health Interview Survey (NHIS), which surveyed
children for their health experiences over a 12-
month period, 25 percent of those children reported
experiencing a great deal of pain or discomfort due
to asthma either often or all the time during the
previous 12 months.
(22) Managing asthma requires a long-term,
multifaceted approach, including patient education,
behavior changes, avoidance of asthma triggers,
pharmacologic therapy, and frequent medical follow-
up.
(23) Enhancing the available prevention, edu-
cational, research, and treatment resources with re-
spect to asthma in the United States will allow our
Nation to address more effectively the problems as-
sociated with this increasing threat to the health and
well-being of our citizens.
award grants to eligible entities to carry out the pur-
poses of this section, including grants that are de-
signed to develop and expand projects to—
‘‘(A) provide comprehensive asthma serv-
ices to children, including access to care and
treatment for asthma in a community-based
setting;
‘‘(B) fully equip mobile health care clinics
that provide preventive asthma care including
diagnosis, 
physical 
examinations, 
pharma-
cological therapy, skin testing, peak flow meter
testing, and other asthma-related health care
services;
‘‘(C) conduct study validated asthma man-
agement education programs for patients with
asthma and their families, including patient
education regarding asthma management, fam-
ily education on asthma management, and the
distribution of materials, including displays and
videos, to reinforce concepts presented by med-
ical teams; and
‘‘(D) identify eligible children for the med-
icaid program under title XIX, the State Chil-
dren’s Health Insurance Program under title
XXI, or other children’s health programs.
‘‘(2) AWARD OF GRANTS.—
‘‘(A) APPLICATION.—
‘‘(i) IN GENERAL.—An eligible entity
shall submit an application to the Sec-
retary for a grant under this section in
such form and manner as the Secretary
may require.
‘‘(ii) REQUIRED
INFORMATION.—An
application submitted under this subpara-
graph shall include a plan for the use of
funds awarded under the grant and such
other information as the Secretary may re-
quire.
‘‘(B) REQUIREMENT.—In awarding grants
under this section, the Secretary shall give pref-
erence to eligible entities that demonstrate that
the activities to be carried out under this sec-
tion shall be in localities within areas of known
high prevalence of childhood asthma or high
asthma-related mortality (relative to the aver-
age asthma incidence rates and associated mor-
tality rates in the United States). Acceptable
data sets to demonstrate a high prevalence of
childhood asthma or high asthma-related mor-
tality may include data from Federal, State, or
local vital statistics, title XIX or XXI claims
data, other public health statistics or surveys,
or other data that the Secretary, in consultation
with the Director of the Centers for Disease
Control and Prevention, deems appropriate.
‘‘(3) DEFINITION
OF
ELIGIBLE
ENTITY.—In
this section, the term ‘eligible entity’ means a State
agency or other entity receiving funds under this
title, a local community, a nonprofit children’s hos-
pital or foundation, or a nonprofit community-based
organization.
‘‘(c) COORDINATION WITH OTHER CHILDREN’S PRO-
GRAMS.—An eligible entity shall identify in the plan sub-
mitted as part of an application for a grant under this
section how the entity will coordinate operations and ac-
tivities under the grant with—
‘‘(1) other programs operated in the State that
serve children with asthma, including any such pro-
grams operated under this title, title XIX, and title
XXI; and
‘‘(2) one or more of the following—
‘‘(A) the child welfare and foster care and
adoption assistance programs under parts B
and E of title IV;
‘‘(B) the head start program established
under the Head Start Act (42 U.S.C. 9831 et
seq.);
‘‘(C) the program of assistance under the
special supplemental nutrition program for
women, infants and children (WIC) under sec-
tion 17 of the Child Nutrition Act of 1966 (42
U.S.C. 1786);
‘‘(D) local public and private elementary or
secondary schools; or
‘‘(E) public housing agencies, as defined in
section 3 of the United States Housing Act of
1937 (42 U.S.C. 1437a).
‘‘(d) EVALUATION.—An eligible entity that receives
a grant under this section shall submit to the Secretary
an evaluation of the operations and activities carried out
under the grant that includes—
‘‘(1) a description of the health status outcomes
of children assisted under the grant;
‘‘(2) an assessment of the utilization of asthma-
related health care services as a result of activities
carried out under the grant;
‘‘(3) the collection, analysis, and reporting of
asthma data according to guidelines prescribed by
the Director of the Centers for Disease Control and
Prevention; and
‘‘(4) such other information as the Secretary
may require.
‘‘(e) APPLICATION
OF
OTHER
PROVISIONS
OF
TITLE.—
‘‘(1) IN GENERAL.—Except as provided in para-
graph (2), the other provisions of this title shall not
apply to a grant made under this section.
‘‘(2) EXCEPTIONS.—The following provisions of
this title shall apply to a grant made under this sec-
tion to the same extent and in the same manner as
such provisions apply to allotments made under sec-
tion 502(c):
‘‘(A) Section 504(b)(4) (relating to ex-
penditures of funds as a condition of receipt of
Federal funds).
‘‘(B) Section 504(b)(6) (relating to prohi-
bition on payments to excluded individuals and
entities).
‘‘(C) Section 506 (relating to reports and
audits, but only to the extent determined by the
Secretary to be appropriate for grants made
under this section).
‘‘(D) 
Section 
508 
(relating 
to 
non-
discrimination).
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There
are authorized to be appropriated to carry out this section
$50,000,000 for each of the fiscal years 2000 through
2004.’’.
SEC. 4. INCORPORATION OF ASTHMA PREVENTION TREAT-
MENT AND SERVICES INTO STATE CHIL-
DREN’S HEALTH INSURANCE PROGRAMS.
(a) IN GENERAL.—The Secretary of Health and
Human Services shall, in accordance with subsection (b),
carry out a program to encourage States to implement
plans to carry out activities to assist children with respect
to asthma in accordance with guidelines of the National
Asthma Education and Prevention Program (NAEPP)
and the National Heart, Lung and Blood Institute.
(b) RELATION TO CHILDREN’S HEALTH INSURANCE
PROGRAM.—
(1) IN GENERAL.—Subject to paragraph (2), if
a State child health plan under title XXI of the So-
cial Security Act (42 U.S.C. 1397aa et seq.) pro-
vides for activities described in subsection (a) to an
extent satisfactory to the Secretary, the Secretary
shall, with amounts appropriated under subsection
(c), make a grant to the State involved to assist the
State in carrying out such activities.
(2) CRITERIA
REGARDING
ELIGIBILITY
FOR
GRANT.—The Secretary shall publish in the Federal
Register criteria describing the circumstances in
which the Secretary will consider a State plan to be
satisfactory for purposes of paragraph (1).
(3) REQUIREMENT OF MATCHING FUNDS.—
(A) IN
GENERAL.—With respect to the
costs of the activities to be carried out by a
State pursuant to paragraph (1), the Secretary
may make a grant under such paragraph only
if the State agrees to make available (directly
or through donations from public or private en-
tities) non-Federal contributions toward such
costs in an amount that is not less than 15 per-
cent of the costs.
(B) DETERMINATION
OF
AMOUNT
CON-
TRIBUTED.—Non-Federal 
contributions 
re-
quired in subparagraph (A) may be in cash or
in kind, fairly evaluated, including equipment or
services. Amounts provided by the Federal Gov-
ernment, or services assisted or subsidized to
any significant extent by the Federal Govern-
ment, may not be included in determining the
amount of such non-Federal contributions.
(4) TECHNICAL ASSISTANCE.—With respect to
State child health plans under title XXI of the So-
cial Security Act (42 U.S.C. 1397aa et seq.), the
Secretary, acting through the Director of the Cen-
ters for Disease Control and Prevention, in consulta-
tion with the heads of other Federal agencies in-
volved in asthma treatment and prevention, shall
make available to the States technical assistance in
developing the provision of such plans that will pro-
vide for activities pursuant to paragraph (1).
(c) FUNDING.—For the purpose of carrying out this
section, there is authorized to be appropriated $5,000,000
for each of the fiscal years 2000 through 2004.
SEC. 5. PREVENTIVE HEALTH AND HEALTH SERVICES
BLOCK GRANT; SYSTEMS FOR REDUCING
ASTHMA AND ASTHMA-RELATED ILLNESSES
THROUGH 
URBAN 
COCKROACH 
MANAGE-
MENT.
Section 1904(a)(1) of the Public Health Service Act
(42 U.S.C. 300w–3(a)(1)) is amended—
(1) by redesignating subparagraphs (E) and
(F) as subparagraphs (F) and (G), respectively;
(2) by adding a period at the end of subpara-
graph (G) (as so redesignated);
(3) by inserting after subparagraph (D), the
following:
‘‘(E) The establishment, operation, and coordi-
nation of effective and cost-efficient systems to re-
duce the prevalence of asthma and asthma-related
illnesses among urban populations, especially chil-
dren, by reducing the level of exposure to cockroach
allergen through the use of integrated pest manage-
ment, as applied to cockroaches. Amounts expended
for such systems may include the costs of structural
rehabilitation of housing, public schools, and other
public facilities to reduce cockroach infestation, the
costs of building maintenance, and the costs of pro-
grams to promote community participation in the
carrying out at such sites integrated pest manage-
ment, as applied to cockroaches. For purposes of
this subparagraph, the term ‘integrated pest man-
agement’ means an approach to the management of
pests in public facilities that minimizes or avoids the
use of pesticide chemicals through a combination of
appropriate practices regarding the maintenance,
cleaning, and monitoring of such sites.’’;
(4) in subparagraph (F) (as so redesignated),
by striking ‘‘subparagraphs (A) through (D)’’ and
inserting ‘‘subparagraphs (A) through (E)’’; and
(5) in subparagraph (G) (as so redesignated),
by striking ‘‘subparagraphs (A) through (E)’’ and
inserting ‘‘subparagraphs (A) through (F)’’.
SEC. 6. COORDINATION OF FEDERAL ACTIVITIES TO AD-
DRESS 
ASTHMA-RELATED 
HEALTH 
CARE
NEEDS.
(a) IN GENERAL.—The Director of the National
Heart, Lung, and Blood Institute shall, through the Na-
tional Asthma Education Prevention Program Coordi-
nating Committee—
(1) identify all Federal programs that carry out
asthma-related activities;
(2) develop, in consultation with appropriate
Federal agencies and professional and voluntary
health organizations, a Federal plan for responding
to asthma; and
(3) not later than 12 months after the date of
enactment of this Act, submit recommendations to
Congress on ways to strengthen and improve the co-
ordination of asthma-related activities of the Federal
Government.
(b) REPRESENTATION
OF
THE DEPARTMENT
OF
HOUSING AND URBAN DEVELOPMENT.—A representative
of the Department of Housing and Urban Development
shall be included on the National Asthma Education Pre-
vention Program Coordinating Committee for the purpose
of performing the tasks described in subsection (a).
(c) AUTHORIZATION OF APPROPRIATIONS.—Out of
any funds otherwise appropriated for the National Insti-
tutes of Health, $5,000,000 shall be made available to the
National Asthma Education Prevention Program for the
period of fiscal years 2000 through 2004 for the purpose
of carrying out this section. Funds made available under
this subsection shall be in addition to any other funds ap-
propriated to the National Asthma Education Prevention
Program for any fiscal year during such period.
SEC. 7. COMPILATION OF DATA BY THE CENTERS FOR DIS-
EASE CONTROL AND PREVENTION.
(a) IN GENERAL.—The Director of the Centers for
Disease Control and Prevention, in consultation with the
National Asthma Education Prevention Program Coordi-
nating Committee, shall—
(1) conduct local asthma surveillance activities
to collect data on the prevalence and severity of
asthma and the quality of asthma management,
including—