[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4654 Introduced in House (IH)]







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 concerned

_______________________________________________________________________

                                 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 Representatives 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 estimated 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 preventable 
        hospitalizations. Improper diagnosis and poor management of 
        asthma resulted in 1.6 million people being treated for asthma 
        attacks in the emergency 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 properly managed. 
        Most asthma-related deaths are preventable, yet such deaths 
        continue to rise in the U.S. In 1994, 5,487 children died as a 
        result of an asthma 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 treatment, and patient education 
        and self-management, asthma is a controllable disease.
            (6) Public health interventions have been proven effective 
        in the treatment and management of asthma. Population-based 
        research supported by the National Institutes of Health (NIH) 
        has effectively demonstrated the benefits of combining 
        aggressive medical treatment with patient education to improve 
        the management of asthma. The National Asthma Education and 
        Prevention Program (NAEPP) helps raise awareness that asthma is 
        a serious chronic disease, and helps promote more effective 
        management of asthma through patient and professional 
        education.
            (7) The alarming rise in prevalence, asthma-related deaths, 
        and expenditures demonstrate that, despite extensive knowledge 
        on effective asthma management strategies, current federal 
        policy and funding regarding the education, treatment, and 
        management of asthma is inadequate.
            (8) Additional federal direction, funding, and support is 
        necessary to increase awareness of asthma as a chronic illness, 
        its symptoms, and the environmental factors (indoor and 
        outdoor) that affect the disease, as well as to promote 
        education programs that teach patients how to better manage 
        asthma.

SEC. 3. PROVISIONS REGARDING NATIONAL ASTHMA EDUCATION AND PREVENTION 
              PROGRAM OF NATIONAL HEART, LUNG, AND BLOOD INSTITUTE.

    (a) Additional Funding; Expansion of Program.--In addition to any 
other authorization of appropriations 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 preceding sentence shall be expended to expand such Program.
    (b) Coordinating Committee.--
            (1) Report to congress.--With respect to the coordinating 
        committee established for the National 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 committee 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 coordinating the asthma-
                related activities of the Federal Government.
            (2) Inclusion of representative of department of 
        education.--The Secretary of Education or a designee of the 
        Secretary shall be included in the membership of the 
        coordinating committee 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 purpose of carrying out activities in accordance 
with subsection (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 expand 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 ``Secretary'') 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-related services, 
        including such services for low-income individuals. The grant 
        may be expended to make arrangements to coordinate the 
        activities of such entities 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 preference to applicants that 
will carry out projects under such subsection in communities that are 
disproportionately affected by asthma or underserved with respect to 
the activities 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; FINANCIAL INCENTIVES 
              REGARDING CHILDREN'S HEALTH INSURANCE PROGRAM.

    (a) In General.--The Secretary of Health and Human Services (in 
this section referred to as the ``Secretary'') 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 asthma 
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 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) 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 entities) non-Federal contributions toward such 
costs in an amount that is not less than 50 percent of the costs ($1 
for each $1 of Federal funds provided in the grant).
                    (B) Determination of amount contributed.--Non-
                Federal contributions required in subparagraph (A) may 
                be in cash or in kind, fairly evaluated, including 
                plant, equipment, or services. Amounts provided by the 
                Federal Government, or services assisted or subsidized 
                to any significant extent by the Federal Government, 
                may not be included in determining the amount of such 
                non-Federal contributions.
            (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 
        assistance 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 
        agencies 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 individuals (as defined by the Secretary).
    (b) Development of Programs.--Programs under subsection (a) shall 
include grants under which local education agencies and State public 
health officials collaborate to develop programs to improve the 
management of asthma in school settings.
    (c) Certain Guidelines.--Programs under subsection (a) shall be 
carried out in accordance with applicable 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 recognition 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 authorize 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 patients 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 guidelines 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 IMPLEMENTATION 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 recommendations of the 
        Public Health Service on asthma 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 asthma.
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