[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 805 Introduced in Senate (IS)]







106th CONGRESS
  1st Session
                                 S. 805

    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 SENATE OF THE UNITED STATES

                             April 15, 1999

  Mr. Durbin (for himself, Mr. DeWine, Mr. Kennedy, and Mr. Schumer) 
introduced the following bill; which was read twice and referred to the 
                          Committee on Finance

_______________________________________________________________________

                                 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 Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Children's Asthma Relief Act of 
1999''.

SEC. 2. FINDINGS.

    (a) Findings.--Congress makes the following findings:
            (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 Illinois, the mortality rate for blacks from asthma 
        is the highest in the nation with 60.8 deaths per every 
        1,000,000 population. In Ohio, the mortality rate for blacks 
        from asthma is 32.2 per 1,000,000 population and the mortality 
        rate for whites from asthma is 11.7 per 1,000,000.
            (4) In 1995, there were more than 1,800,000 emergency room 
        visits made for asthma-related attacks 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.
            (5) Hospitalization rates were highest for individuals 4 
        years old and younger, and were 10.9 per 10,000 visits for 
        whites and 35.5 per 10,000 visits for blacks.
            (6) From 1979 to 1992, the hospitalization rates among 
        children due to asthma increased 74 percent.
            (7) It is estimated that more than 7 percent of children 
        now have asthma.
            (8) Although asthma can occur at any age, about 80 percent 
        of the children who will develop asthma do so before starting 
        school.
            (9) 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).
            (10) 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.
            (11) Children aged 0 to 5 years who are exposed to maternal 
        smoking are 201 times more likely to develop asthma compared 
        with those free from exposure.
            (12) Morbidity and mortality related to childhood asthma 
        are disproportionately high in urban areas.
            (13) 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.
            (14) 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.
            (15) Research supported by the National Institutes of 
        Health demonstrated that the combination of cockroach allergen, 
        house dust mites, molds, tobacco smoke, and feathers are 
        important causes of asthma-related illness and hospitalization 
        among children in inner-city areas of the United States.
            (16) Cities outside the United States have developed and 
        implemented effective systems of cockroach management.
            (17) Integrated pest management is a cost-effective 
        approach to pest control that emphasizes prevention and uses a 
        range of techniques, including property maintenance and 
        cleaning, and pesticides as a means of last resort.
            (18) Reducing exposure to cockroach allergen, as part of an 
        integrated approach to asthma management, may be a cost-
        effective way of reducing the social and economic costs of the 
        disease.
            (19) No current Federal funding exists specifically to 
        assist cities in developing and implementing integrated 
        strategies to reduce cockroach infestation.
            (20) 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.
            (21) According to a 1995 National Institute of Health 
        workshop report, missed school days accounted for an estimated 
        cost of lost productivity for parents of children with asthma 
        of almost $1,000,000,000 per year.
            (22) 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.
            (23) Managing asthma requires a long-term, multifaceted 
        approach, including patient education, behavior changes, 
        avoidance of asthma triggers, pharmacologic therapy, and 
        frequent medical follow-up.
            (24) Enhancing the available prevention, educational, 
        research, and treatment resources with respect to asthma in the 
        United States will allow our Nation to address more effectively 
        the problems associated with this increasing threat to the 
        health and well-being of our citizens.

SEC. 3. CHILDREN'S ASTHMA RELIEF.

    Title V of the Social Security Act (42 U.S.C. 701 et seq.) is 
amended by adding at the end the following:

``SEC. 511. ASTHMA TREATMENT GRANTS PROGRAM.

    ``(a) Purposes.--The purposes of this section are as follows:
            ``(1) To provide access to quality medical care for 
        children who live in areas that have a high prevalence of 
        asthma and who lack access to medical care.
            ``(2) To provide on-site education to parents, children, 
        health care providers, and medical teams to recognize the signs 
        and symptoms of asthma, and to train them in the use of 
        medications to prevent and treat asthma.
            ``(3) To decrease preventable trips to the emergency room 
        by making medication available to individuals who have not 
        previously had access to treatment or education in the 
        prevention of asthma.
            ``(4) To provide other services, such as smoking cessation 
        programs, home modification, and other direct and support 
        services that ameliorate conditions that exacerbate or induce 
        asthma.
    ``(b) Authority To Make Grants.--
            ``(1) In general.--In addition to any other payments made 
        under this title, the Secretary shall award grants to eligible 
        entities to carry out the purposes of this section, including 
        grants that are designed to develop and expand projects to--
                    ``(A) provide comprehensive asthma services 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, pharmacological therapy, skin 
                testing, peak flow meter testing, and other asthma-
                related health care services;
                    ``(C) conduct study validated asthma management 
                education programs for patients with asthma and their 
                families, including patient education regarding asthma 
                management, family education on asthma management, and 
                the distribution of materials, including displays and 
                videos, to reinforce concepts presented by medical 
                teams; and
                    ``(D) identify eligible children for the medicaid 
                program under title XIX, the State Children'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 Secretary for a 
                        grant under this section in such form and 
                        manner as the Secretary may require.
                            ``(ii) Required information.--An 
                        application submitted under this subparagraph 
                        shall include a plan for the use of funds 
                        awarded under the grant and such other 
                        information as the Secretary may require.
                    ``(B) Requirement.--In awarding grants under this 
                section, the Secretary shall give preference to 
                eligible entities that demonstrate that the activities 
                to be carried out under this section shall be in 
                localities within areas of known high prevalence of 
childhood asthma or high asthma-related mortality (relative to the 
average asthma incidence rates and associated mortality rates in the 
United States). Acceptable data sets to demonstrate a high prevalence 
of childhood asthma or high asthma-related mortality 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 hospital or foundation, or a nonprofit 
        community-based organization.
    ``(c) Coordination With Other Children's Programs.--An eligible 
entity shall identify in the plan submitted as part of an application 
for a grant under this section how the entity will coordinate 
operations and activities under the grant with--
            ``(1) other programs operated in the State that serve 
        children with asthma, including any such programs 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 section 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 paragraph (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 section to the same 
        extent and in the same manner as such provisions apply to 
        allotments made under section 502(c):
                    ``(A) Section 504(b)(4) (relating to expenditures 
                of funds as a condition of receipt of Federal funds).
                    ``(B) Section 504(b)(6) (relating to prohibition 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 nondiscrimination).
    ``(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 TREATMENT AND SERVICES INTO 
              STATE CHILDREN'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 Social Security Act (42 
        U.S.C. 1397aa et seq.) 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) 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 entities) non-Federal contributions toward such 
                costs in an amount that is not less than 15 percent of 
                the costs.
                    (B) Determination of amount contributed.--Non-
                Federal contributions required in subparagraph (A) may 
                be in cash or in kind, fairly evaluated, including 
                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.
            (4) Technical assistance.--With respect to State child 
        health plans under title XXI of the Social Security Act (42 
        U.S.C. 1397aa et seq.), the Secretary, acting through the 
        Director of the Centers for Disease Control and Prevention, in 
        consultation with the heads of other Federal agencies involved 
        in asthma treatment and prevention, shall make available to the 
        States technical assistance in developing the provision 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 2000 through 2004.

SEC. 5. PREVENTIVE HEALTH AND HEALTH SERVICES BLOCK GRANT; SYSTEMS FOR 
              REDUCING ASTHMA AND ASTHMA-RELATED ILLNESSES THROUGH 
              URBAN COCKROACH MANAGEMENT.

    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 subparagraph (G) (as 
        so redesignated);
            (3) by inserting after subparagraph (D), the following:
            ``(E) The establishment, operation, and coordination of 
        effective and cost-efficient systems to reduce the prevalence 
        of asthma and asthma-related illnesses among urban populations, 
        especially children, by reducing the level of exposure to 
        cockroach allergen through the use of integrated pest 
        management, 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 programs to promote community 
        participation in the carrying out at such sites integrated pest 
        management, as applied to cockroaches. For purposes of this 
        subparagraph, the term `integrated pest management' 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 ADDRESS ASTHMA-RELATED 
              HEALTH CARE NEEDS.

    (a) In General.--The Director of the National Heart, Lung, and 
Blood Institute shall, through the National Asthma Education Prevention 
Program Coordinating 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 coordination 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 
Prevention 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 Institutes 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 appropriated to the National 
Asthma Education Prevention Program for any fiscal year during such 
period.

SEC. 7. COMPILATION OF DATA BY THE CENTERS FOR DISEASE 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 Coordinating 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--
                    (A) telephone surveys to collect sample household 
                data on the local burden of asthma; and
                    (B) health care facility specific surveillance to 
                collect asthma data on the prevalence and severity of 
                asthma, and on the quality of asthma care; and
            (2) compile and annually publish data on--
                    (A) the prevalence of children suffering from 
                asthma in each State; and
                    (B) the childhood mortality rate associated with 
                asthma nationally and in each State.
    (b) Collaborative Efforts.--The activities described in subsection 
(a)(1) may be conducted in collaboration with eligible entities awarded 
a grant under section 511 of the Social Security Act (as added by 
section 3).
                                 <all>