I
105TH CONGRESS
2D SESSION
H. R. 4654
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
SEPTEMBER 28, 1998
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 con-
cerned
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.
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 ‘‘Asthma Act’’.
SEC. 2. FINDINGS.
The Congress finds as follows:
(1) Despite improved therapies, the prevalence
rate of asthma continues to rise, affecting an esti-
mated 14.6 million Americans; 4.8 million under the
age of 18. Since 1984, the prevalence of pediatric
asthma has risen 72 percent. Rates are increasing
for all ethnic groups and especially for African
American and Hispanic children.
(2) Asthma is the third leading cause of pre-
ventable hospitalizations. Improper diagnosis and
poor management of asthma resulted in 1.6 million
people being treated for asthma attacks in the emer-
gency room in 1997. According to recent studies,
asthma accounts for 17 percent of all pediatric
emergency room visits.
(3) Asthma can be life-threatening if not prop-
erly managed. Most asthma-related deaths are pre-
ventable, yet such deaths continue to rise in the U.S.
In 1994, 5,487 children died as a result of an asth-
ma attack, representing a six percent increase in
deaths from 1993 and a doubling since 1979.
(4) Asthma costs the U.S. over $12 billion a
year and the rise is asthma prevalence will lead to
higher costs in the future.
(5) With early recognition of the signs and
symptoms of asthma, proper diagnosis and treat-
grams that teach patients how to better manage
asthma.
SEC. 3. PROVISIONS REGARDING NATIONAL ASTHMA EDU-
CATION AND PREVENTION PROGRAM OF NA-
TIONAL HEART, LUNG, AND BLOOD INSTI-
TUTE.
(a) ADDITIONAL FUNDING; EXPANSION
OF PRO-
GRAM.—In addition to any other authorization of appro-
priations that is available to the National Heart, Lung,
and Blood Institute for the purpose of carrying out the
National Asthma Education and Prevention Program,
there is authorized to be appropriated to such Institute
for such purpose $5,000,000 for each of the fiscal years
1999 through 2003. Amounts appropriated under the pre-
ceding sentence shall be expended to expand such Pro-
gram.
(b) COORDINATING COMMITTEE.—
(1) REPORT TO CONGRESS.—With respect to
the coordinating committee established for the Na-
tional Asthma Education and Prevention Program of
the National Heart, Lung, and Blood Institute, such
committee shall submit to the Congress a report
that—
(A) contains a determination by the com-
mittee of the scope of the problem of asthma in
the United States;
(B) identifies all Federal programs that
carry out asthma-related activities; and
(C) contains the recommendations of the
committee for strengthening and better coordi-
nating the asthma-related activities of the Fed-
eral Government.
(2) INCLUSION
OF
REPRESENTATIVE
OF
DE-
PARTMENT OF EDUCATION.—The Secretary of Edu-
cation or a designee of the Secretary shall be in-
cluded in the membership of the coordinating com-
mittee referred to in paragraph (1).
SEC. 4. ASTHMA-RELATED ACTIVITIES OF CENTERS FOR
DISEASE CONTROL AND PREVENTION.
(a) ADDITIONAL FUNDING.—In addition to any other
authorization of appropriations that is available to the
Centers for Disease Control and Prevention for the pur-
pose of carrying out activities in accordance with sub-
section (b), there is authorized to be appropriated to such
Centers for such purpose $5,000,000 for each of the fiscal
years 1999 through 2003.
(b) EXPANSION OF PUBLIC HEALTH SURVEILLANCE
ACTIVITIES; PROGRAM
FOR PROVIDING INFORMATION
AND EDUCATION TO PUBLIC.—For purposes of subsection
(a), the Secretary of Health and Human Services, acting
through the Director of the Centers for Disease Control
and Prevention, shall collaborate with the States to ex-
pand the scope of—
(1) activities that are carried out to determine
the incidence and prevalence of asthma; and
(2) activities that are carried out to prevent the
health consequences of asthma, including through
the provision of information and education to the
public regarding asthma, which may include the use
of public service announcements through the media
and such other means as such Director determines
to be appropriate.
SEC. 5. GRANTS FOR COMMUNITY OUTREACH REGARDING
ASTHMA INFORMATION, EDUCATION, AND
SERVICES.
(a) IN GENERAL.—The Secretary of Health and
Human Services (in this section referred to as the ‘‘Sec-
retary’’) may make grants to nonprofit private entities for
projects to carry out, in communities identified by entities
applying for the grants, outreach activities to provide for
residents of the communities the following:
(1) Information and education on asthma.
(2) Referrals to health programs of public and
nonprofit private entities that provide asthma-relat-
ed services, including such services for low-income
individuals. The grant may be expended to make ar-
rangements to coordinate the activities of such enti-
ties in order to establish and operate networks or
consortia regarding such referrals.
(b) PREFERENCES IN MAKING GRANTS.—In making
grants under subsection (a), the Secretary shall give pref-
erence to applicants that will carry out projects under such
subsection in communities that are disproportionately af-
fected by asthma or underserved with respect to the activi-
ties described in such subsection and in which a significant
number of low-income individuals reside.
(c) EVALUATIONS.—A condition for a grant under
subsection (a) is that the applicant for the grant agree
to provide for the evaluation of the projects carried out
under such subsection by the applicant to determine the
extent to which the projects have been effective in carrying
out the activities referred to in such subsection.
(d) FUNDING.—For the purpose of carrying out this
section, there is authorized to be appropriated $5,000,000
for each of the fiscal years 1999 through 2003.
SEC. 6. ACTION PLANS OF STATES REGARDING ASTHMA; FI-
NANCIAL 
INCENTIVES 
REGARDING 
CHIL-
DREN’S HEALTH INSURANCE PROGRAM.
(a) IN GENERAL.—The Secretary of Health and
Human Services (in this section referred to as the ‘‘Sec-
retary’’) shall in accordance with subsection (b) carry out
a program to encourage the States to implement plans to
carry out activities to assist children with respect to asth-
ma in accordance with guidelines of 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 plan under title XXI of the Social Security
Act provides for activities described in subsection (a)
to an extent satisfactory to the Secretary, the Sec-
retary shall, with amounts appropriated under sub-
section (c), make a grant to the State involved to as-
sist the State in carrying out such activities.
(2) 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 50 per-
cent of the costs ($1 for each $1 of Federal
funds provided in the grant).
(B) DETERMINATION
OF
AMOUNT
CON-
TRIBUTED.—Non-Federal 
contributions 
re-
quired in subparagraph (A) may be in cash or
in kind, fairly evaluated, including plant, equip-
ment, or services. Amounts provided by the
Federal Government, or services assisted or
subsidized to any significant extent by the Fed-
eral Government, may not be included in deter-
mining the amount of such non-Federal con-
tributions.
(3) 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).
(4) TECHNICAL ASSISTANCE.—With respect to
State plans under title XXI of the Social Security
Act, the Secretary, acting through the Director of
the Centers for Disease Control and Prevention,
shall make available to the States technical assist-
ance in developing the provisions of such plans that
will provide 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 1999 through 2003.
SEC. 7. ACTION PLANS OF LOCAL EDUCATIONAL AGENCIES
REGARDING ASTHMA.
(a) IN GENERAL.—
(1) SCHOOL-BASED ASTHMA ACTIVITIES.—The
Secretary of Education (in this section referred to as
the ‘‘Secretary’’), in consultation with the Director
of the Centers for Disease Control and Prevention
and the Director of the National Institutes of
Health, may make grants to local educational agen-
cies for programs to carry out at elementary and
secondary schools specified in paragraph (2) asthma-
related activities for children who attend such
schools.
(2) ELIGIBLE SCHOOLS.—The elementary and
secondary schools referred to in paragraph (1) are
such schools that are located in communities with a
significant number of low-income or underserved in-
dividuals (as defined by the Secretary).
(b) DEVELOPMENT OF PROGRAMS.—Programs under
subsection (a) shall include grants under which local edu-
cation agencies and State public health officials collabo-
rate to develop programs to improve the management of
asthma in school settings.
(c) CERTAIN GUIDELINES.—Programs under sub-
section (a) shall be carried out in accordance with applica-
ble guidelines or other recommendations of the National
Institutes of Health (including the National Heart, Lung,
and Blood Institute) and the Environmental Protection
Agency.
(d) CERTAIN ACTIVITIES.—Activities that may be
carried out in programs under subsection (a) include the
following:
(1) Identifying and working directly with local
hospitals, community clinics, advocacy organizations,
parent-teacher associations, and asthma coalitions.
(2) Identifying asthmatic children and training
them and their families in asthma self-management.
(3) Purchasing asthma equipment.
(4) Hiring school nurses.
(5) Training teachers, nurses, coaches, and
other school personnel in asthma-symptom recogni-
tion and emergency responses.
(6) Simplifying procedures to improve students’
safe access to their asthma medications.
(7) Such other asthma-related activities as the
Secretary determines to be appropriate.
(e) USE OF TITLE I FUNDS.—The Secretary may au-
thorize a local educational agency carrying out a program
under subsection (a) to expend for such program not more
than 5 percent of amounts received by such agency under
title I of the Elementary and Secondary Education Act
of 1965.
(f) DEFINITIONS.—For purposes of this section, the
terms ‘‘elementary school’’, ‘‘local educational agency’’,
and ‘‘secondary school’’ have the meanings given such
terms in the Elementary and Secondary Education Act of
1965.
(g) FUNDING.—For the purpose of carrying out this
section, there is authorized to be appropriated $5,000,000
for each of the fiscal years 1999 through 2003.
SEC. 8. SENSE OF CONGRESS REGARDING HOSPITALS AND
MANAGED CARE PLANS.
It is the sense of the Congress that—
(1) hospitals should be encouraged to offer
asthma-related education and training to asthma pa-
tients and their families upon discharge from the
hospital of such patients;
(2) hospitals should, with respect to information
on asthma, establish telephone services for patients
and communicate with providers of primary health
services; and
(3) managed care organizations should—
(A) be encouraged to disseminate to health
care providers asthma clinical practice guide-
lines developed or endorsed by the Public
Health Service;
(B) collect and maintain asthma data; and
(C) offer asthma-related education and
training to asthma patients and their families.
SEC. 9. SENSE OF CONGRESS REGARDING IMPLEMENTA-
TION OF ACT.
It is the sense of the Congress that all Federal, State,
and local asthma-related activities should—
(1) promote the guidelines and other rec-
ommendations of the Public Health Service on asth-
ma diagnosis and management; and
(2) be designed in consultation with national
and local organizations representing the medical,
educational, and environmental communities, as well
as advocates that represent those affected by asth-
ma.
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