I 
116TH CONGRESS 
1ST SESSION H. R. 5438 
To direct the Secretary of Health and Human Services, acting through 
the Director of the Centers for Disease Control and Prevention, to 
award grants to develop programs to increase health care providers’ 
awareness of Valley fever, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
DECEMBER 16, 2019 
Mr. COX of California (for himself, Mr. HARDER of California, Mr. COSTA, 
Mr. GALLEGO, Mr. O’HALLERAN, Mrs. KIRKPATRICK, Mr. PANETTA, and 
Mr. GRIJALVA) introduced the following bill; which was referred to the 
Committee on Energy and Commerce, and in addition to the Committee 
on Ways and Means, 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 concerned 
A BILL 
To direct the Secretary of Health and Human Services, 
acting through the Director of the Centers for Disease 
Control and Prevention, to award grants to develop pro-
grams to increase health care providers’ awareness of 
Valley fever, 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 ‘‘End Valley Fever Now 
Act’’. 
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SEC. 2. GRANTS TO DEVELOP PROGRAMS TO INCREASE 
HEALTH CARE PROVIDERS’ AWARENESS OF 
VALLEY FEVER. 
Part P of title III of the Public Health Service Act 
(42 U.S.C. 280g et seq.) is amended by adding at the end 
the following: 
‘‘SEC. 399V–7. GRANTS TO DEVELOP PROGRAMS TO IN-
CREASE HEALTH CARE PROVIDERS’ AWARE-
NESS OF VALLEY FEVER. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Administrator of the Health Resources and Services 
Administration and in consultation with the Director of 
the Centers for Disease Control and Prevention, shall 
make awards of grants or cooperative agreements to eligi-
ble entities to establish and carry out programs— 
‘‘(1) to increase health care providers’ aware-
ness of Valley fever; and 
‘‘(2) to educate and train health care providers 
on the diagnosis and treatment of Valley fever. 
‘‘(b) USE OF FUNDS.—An eligible entity selected to 
receive a grant or contract under this section shall use 
amounts awarded under such a grant or contract to pro-
vide innovative supportive activities (which may include 
activities that do not rely on the use of broadband serv-
ices) to enhance education through distance learning, con-
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tinuing educational activities, collaborative conferences, 
and electronic and telelearning activities. 
‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
$1,000,000 for the period of fiscal years 2021 through 
2023, to remain available until expended. 
‘‘(d) CONDITION.—A recipient of a grant under this 
section shall, as a condition on receipt of the grant, agree 
to develop curricula for the purposes specified in sub-
section (a) in coordination with local providers at hospitals 
and clinics. 
‘‘(e) DEFINITIONS.—In this section: 
‘‘(1) The term ‘eligible entity’ means— 
‘‘(A) a State department of health (or 
similar State authority); 
‘‘(B) an institution of higher education (as 
defined in section 101 of the Higher Education 
Act of 1965 (20 U.S.C. 1001)), including a 
medical school or continuing medical education 
program at such institution; 
‘‘(C) an entity operating a graduate med-
ical residency training program under section 
340E or under section 340H; or 
‘‘(D) a teaching hospital (as defined in sec-
tion 415.152 of title 42, Code of Federal Regu-
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lations) that has physicians and other medical 
providers with specialized knowledge in diag-
nosing and treating Valley fever. 
‘‘(2) The term ‘Valley fever’ means the condi-
tion caused by Coccidioidomycosis.’’. 
SEC. 3. STUDY COMPARING DIFFERENT CASE DEFINITIONS 
USED TO IDENTIFY VALLEY FEVER. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services, acting through the Director of the Cen-
ters for Disease Control and Prevention shall conduct a 
study comparing different case definitions used to identify 
valley fever. Such study shall include the efficacy of the 
methods being used to establish such case definitions and 
the cost effectiveness of such methods, including using the 
case definition for valley fever established by the Council 
of State and Territorial Epidemiologist. 
(b) VALLEY FEVER DEFINED.—In this Act, the term 
‘‘Valley fever’’ has the meaning given the term in section 
399V–7 of the Public Health Service Act. 
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SEC. 4. ALLOWING STATES TO PROVIDE COVERAGE UNDER 
THE MEDICAID PROGRAM FOR ITEMS AND 
SERVICES FURNISHED IN CONNECTION WITH 
QUALIFYING 
VALLEY 
FEVER 
CLINICAL 
TRIALS. 
(a) IN GENERAL.—Section 1905(a) of the Social Se-
curity Act (42 U.S.C. 1396d(a)) is amended— 
(1) in paragraph (29), by striking ‘‘and’’ at the 
end; 
(2) by redesignating paragraph (30) as para-
graph (31); and 
(3) by inserting after paragraph (29) the fol-
lowing new paragraph: 
‘‘(30) items and services furnished in connec-
tion with participation in a qualifying Valley fever 
clinical trial (as defined in section 2709A(b)(4) of 
the Public Health Service Act), including travel and 
incidental expenses, regardless of whether such items 
and services are furnished by a participating pro-
vider under the Medicaid program (other than a pro-
vider excluded from participation in such program 
under section 1128) or whether such items and serv-
ices are furnished in another State; and’’. 
(b) REDUCTION IN FMAP FOR STATES THAT DO 
NOT PROVIDE COVERAGE.—Section 1905 of the Social 
Security Act (42 U.S.C. 1396d) is amended— 
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(1) in subsection (b), by striking ‘‘and (ff)’’ and 
inserting ‘‘(ff), and (gg)’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(gg) REDUCTION IN FMAP FOR STATES THAT DO 
NOT PROVIDE COVERAGE
FOR CERTAIN ITEMS
AND 
SERVICES.—With respect to a calendar quarter beginning 
on or after January 1, 2021, the Federal medical assist-
ance percentage otherwise determined under subsection 
(b) for a State that does not provide coverage for items 
and services described in subsection (a)(30) that are fur-
nished during such quarter shall be reduced by 5 percent-
age points.’’. 
(c) ENSURING ACCESS FOR MEDICAID EXPANSION 
POPULATION.—Section 1937(b)(5) of such Act is amend-
ed by inserting before the period at the end the following: 
‘‘, and beginning January 1, 2021, coverage of items and 
services described in section 1905(a)(30)’’. 
(d) PROHIBITION ON IMPOSITION OF COSTSHARING 
REQUIREMENTS.—Title XIX of the Social Security Act 
(42 U.S.C. 1396 et seq.) is amended— 
(1) in section 1916(a)(2)— 
(A) in subparagraph (D), by striking ‘‘or’’ 
at the end; 
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‘‘(bb) The Department of 
Defense. 
‘‘(cc) The Department of 
Energy. 
‘‘(ii) The clinical trial is conducted 
under an investigational new drug applica-
tion reviewed by the Food and Drug Ad-
ministration. 
‘‘(iii) The clinical trial is a drug trial 
that is exempt from having such an inves-
tigational new drug application. 
‘‘(B) CONDITIONS.—For purposes of sub-
paragraph (A)(i)(VII), the conditions described 
in this subparagraph, with respect to a clinical 
trial approved or funded by an entity described 
in such subparagraph (A)(i)(VII), are that the 
clinical trial has been reviewed and approved 
through a system of peer review that the Sec-
retary determines— 
‘‘(i) to be comparable to the system of 
peer review of studies and investigations 
used by the National Institutes of Health; 
and 
‘‘(ii) assures unbiased review of the 
highest scientific standards by qualified in-
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