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.
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 ‘‘Tuberculosis Preven-
tion and Control Amendments of 1993’’.
SEC. 2. PROGRAMS OF CENTERS FOR DISEASE CONTROL.
(a) PROVISION OF SERVICES FOR PREVENTION, CON-
TROL, 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 in-
serting ‘‘and 1992’’; and
(C) by inserting before the period the fol-
lowing: ‘‘, $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 addi-
tion to the authorization of appropriations es-
tablished in section 317(j)(2) of the Public
Health Service Act for grants for the preven-
tion, 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 subpara-
graph (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 ac-
tivities under the grant are to be carried out
has, relative to other areas, a substantial inci-
dence of cases of tuberculosis or a substantial
rate of increase in such cases.
(3) BULK PURCHASES.—
(A) Subject to subparagraph (B), in addi-
tion to the authorization of appropriations es-
tablished in section 317(j)(2) of the Public
Health Service Act for grants for the preven-
tion, 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 subpara-
graph (A) shall be administered by the Sec-
retary 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 subpara-
graph, such amounts are available for making
bulk purchases of medications and other sup-
plies 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 pro-
grams may be expended include services with respect
to incarceration.’’.
(b) RESEARCH, DEMONSTRATION PROJECTS, EDU-
CATION, 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 des-
ignation; and
(3) by adding at the end the following subpara-
graph:
‘‘(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 au-
thorization of appropriations established in the preceding
sentence is in addition to the authorization of appropria-
tions established in subsection (j)(2) for carrying out this
paragraph.’’.
(c) TRAINING CENTERS REGARDING HEALTH PRO-
FESSIONALS.—
(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 re-
spect 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) in-
clude screening individuals for tuberculosis, provid-
ing treatment for such disease, and referring individ-
uals for services.
(3) FACILITIES
AND
EQUIPMENT.—The pur-
poses for which the Secretary may authorize an en-
tity to expend a grant under paragraph (1) include
providing for facilities and equipment for the center
under such paragraph.
(4) QUALITY
OF
LABORATORIES.—The Sec-
retary may make a grant under paragraph (1) only
if the entity involved provides assurances satisfac-
tory 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 Sec-
retary and the application is in such form, is made
in such manner, and contains such agreements, as-
surances, and information as the Secretary deter-
mines 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 para-
graph (1) may not exceed 3 years. The provi-
sion of such payments shall be subject to an-
nual approval by the Secretary of the payments
and subject to the availability of appropriations
for the fiscal year involved to make the pay-
ments.
(7) EVALUATIONS; DISSEMINATION OF INFOR-
MATION.—The Secretary shall, directly or through
contracts with public or private entities, provide for
evaluations of centers operated pursuant to para-
graph (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 AL-
LERGY 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 re-
search training regarding the cause, diagnosis, early detec-
tion, 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 follow-
ing: ‘‘(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 Dis-
eases), 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 appropria-
tions.’’.
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 follow-
ing 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 out-
patient medical facilities which are located apart from hos-
pitals and which will provide such services for medically
underserved populations, (B) conversion of existing facili-
ties 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 re-
spect 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 INDI-
VIDUALS.
(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 amend-
ed—
(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 sub-
section (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 sub-
section (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 sub-
section (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 serv-
ices—
‘‘(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 subpara-
graph (F)—