[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4610 Introduced in House (IH)]






108th CONGRESS
  2d Session
                                H. R. 4610

    To amend the Public Health Service Act to provide for arthritis 
          research and public health, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 17, 2004

  Mr. Pickering (for himself and Ms. Eshoo) introduced the following 
    bill; which was referred to the Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
    To amend the Public Health Service Act to provide for arthritis 
          research and public health, 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 ``Arthritis Prevention, Control, and 
Cure Act of 2004''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) Arthritis and other rheumatic diseases are among the 
        most common conditions in the United States. There are more 
        than 100 different forms of arthritis, of which the 2 most 
        common forms are osteoarthritis and rheumatoid arthritis.
            (2) Arthritis and other rheumatic diseases cause severe and 
        chronic pain, swollen tissue, ligament and joint destruction, 
        deformities, permanent disability, and death. Arthritis and 
        other rheumatic diseases erode patients' quality of life and 
        can diminish their mental health, impose significant 
        limitations on their daily activities, and disrupt the lives of 
        their family members and caregivers.
            (3) One out of every 3, or nearly 70,000,000, adults in the 
        United States suffer from arthritis or chronic joint symptoms. 
        The number of individuals in the United States with arthritis 
        will grow as the number of older Americans continues to 
        increase dramatically in the next few decades.
            (4) Arthritis and other rheumatic diseases affect all types 
        of people of the United States, not just older individuals. 
        Arthritis and other rheumatic diseases disproportionately 
        affect women in the United States, and nearly 3 of every 5 
        individuals with arthritis are younger than 65 years of age. 
        Today, 8,400,000 young adults ages 18 through 44 have arthritis 
        and millions of others are at risk for developing the disease.
            (5) Arthritis and other rheumatic diseases are the leading 
        cause of disability among adults in the United States. More 
        than 8,000,000 people in the United States are disabled by 
        arthritis and other rheumatic diseases. By 2020, arthritis will 
        limit the daily activities of nearly 12,000,000 individuals.
            (6) Nearly 60 percent of people of the United States with 
        arthritis are of working age. In general, people with arthritis 
        have a low rate of participation in the workforce. Arthritis is 
        exceeded only by heart disease as a cause of work disability.
            (7) Nearly 300,000 children in the United States, or 3 
        children out of every 1,000, have some form of arthritis or 
        other rheumatic disease. It is the sense of Congress that the 
        substantial morbidity associated with pediatric arthritis 
        warrants a greater Federal investment in research to identify 
        new and more effective treatments for these diseases.
            (8) Arthritis results in 750,000 hospitalizations, 
        44,000,000 outpatient visits, and 4,000,000 days of hospital 
        care every year, according to the Centers for Disease Control 
        and Prevention.
            (9) The Centers for Disease Control and Prevention estimate 
        that the annual cost of medical care for arthritis is 
        $51,000,000, and the estimated annual total cost of arthritis 
        to the United States, including lost productivity, exceeds 
        $86,000,000.
            (10) In 1975, the National Arthritis Act of 1974 (Public 
        Law 93-640) was enacted to promote basic and clinical arthritis 
        research, establish Multipurpose Arthritis Centers, and expand 
        clinical knowledge in the field of arthritis. The Act was 
        successfully implemented, and continued funding of arthritis-
        related research has led to important advances in arthritis 
        control, treatment, and prevention.
            (11) Early diagnosis, treatment, and appropriate management 
        of arthritis can control symptoms and improve quality of life. 
        Weight control and exercise can demonstrably lower health risks 
        from arthritis, as can other forms of patient education, 
        training, and self-management. The genetics of arthritis are 
        being actively investigated. New, innovative, and increasingly 
        effective drug therapies, joint replacements, and other 
        therapeutic options are being developed.
            (12) While research has identified many effective 
        interventions against arthritis, such interventions are broadly 
        underutilized. That underutilization leads to unnecessary loss 
        of life, health, and quality of life, as well as avoidable or 
        unnecessarily high health care costs. Arthritis self-management 
        can reduce both patient pain and health care costs, with some 
        self-management programs reducing arthritis pain by 20 percent 
        and physician visits by 40 percent. Yet less than 1 percent of 
        the 49,000,000 people in the United States with arthritis 
        participate in such programs, and self-management courses are 
        not offered in all areas of the United States.
            (13) Rheumatologists are internists or pediatric sub-
        specialists that are uniquely qualified by an additional 2 to 4 
        years of training and experience in the diagnosis and treatment 
        of rheumatic conditions. Typically, rheumatologists act as 
        consultants, but also often act as managers, relying on the 
        help of many skilled professionals, including nurses, physical 
        and occupational therapists, psychologists, and social workers. 
        Many rheumatologists conduct research to determine the cause 
        and effective treatment of disabling and sometimes fatal 
        rheumatic diseases.
            (14) Recognizing that the Nation requires a public health 
        approach to arthritis, the Department of Health and Human 
        Services established important national goals related to 
        arthritis in its Healthy People 2010 initiative. Moreover, 
        various Federal and non-Federal stakeholders have worked 
        cooperatively to develop a comprehensive National Arthritis 
        Action Plan: A Public Health Strategy.
            (15) Greater efforts and commitments are needed from 
        Congress, the States, providers, and patients to achieve the 
        goals of Healthy People 2010, implement a national public 
        health strategy consistent with the National Arthritis Action 
        Plan, and lessen the burden of arthritis on citizens of the 
        United States.

SEC. 3. ENHANCING THE PUBLIC HEALTH ACTIVITIES RELATED TO ARTHRITIS OF 
              THE CENTERS FOR DISEASE CONTROL AND PREVENTION THROUGH 
              THE NATIONAL ARTHRITIS ACTION PLAN.

    Part B of title III of the Public Health Service Act (42 U.S.C. 243 
et seq.) is amended by inserting after section 314 the following:

``SEC. 315. IMPLEMENTATION OF THE NATIONAL ARTHRITIS ACTION PLAN.

    ``The Secretary shall develop and implement a National Arthritis 
Action Plan that consists of--
            ``(1) the Federal arthritis prevention and control 
        activities, as described in section 315A;
            ``(2) the State arthritis control and prevention programs, 
        as described in section 315B;
            ``(3) the comprehensive arthritis action grant program, as 
        described in section 315C; and
            ``(4) a national arthritis education and outreach program, 
        as described in section 315D.

``SEC. 315A. FEDERAL ARTHRITIS PREVENTION AND CONTROL ACTIVITIES.

    ``(a) In General.--The Secretary, acting through the Director of 
the Centers for Disease Control and Prevention, shall, directly, or 
through a grant to an eligible entity, conduct, support, and promote 
the coordination of research, investigations, demonstrations, training, 
and studies relating to the control, prevention, and surveillance of 
arthritis and other rheumatic diseases.
    ``(b) Duties of Secretary.--The activities of the Secretary under 
subsection (a) shall include--
            ``(1) the collection, publication, and analysis of data on 
        the prevalence and incidence of arthritis and other rheumatic 
        diseases;
            ``(2) the development of uniform data sets for public 
        health surveillance and clinical quality improvement 
        activities;
            ``(3) the identification of evidence-based and cost-
        effective best practices for the prevention, diagnosis, 
        management, and care of arthritis and other rheumatic diseases;
            ``(4) research, including research on behavioral 
        interventions to prevent arthritis and on other evidence-based 
        best practices relating to arthritis prevention, diagnosis, 
        management, and care; and
            ``(5) demonstration projects, including community-based and 
        patient self-management programs of arthritis control, 
        prevention, and care, and similar collaborations with academic 
        institutions, hospitals, health insurers, researchers, health 
        professionals, and nonprofit organizations.
    ``(c) Training and Technical Assistance.--With respect to the 
planning, development, and operation of any activity carried out under 
subsection (a), the Secretary may provide training, technical 
assistance, supplies, equipment, or services, and may assign any 
officer or employee of the Department of Health and Human Services to a 
State or local health agency, or to any public or nonprofit entity 
designated by a State health agency, in lieu of providing grant funds 
under this section.
    ``(d) Arthritis Prevention Research at the Centers for Disease 
Control and Prevention Centers.--The Secretary shall provide additional 
grant support for research projects at the Centers for Prevention 
Research by the Centers for Disease Control and Prevention to encourage 
the expansion of research portfolios at the Centers for Prevention 
Research to include arthritis-specific research activities related to 
the prevention and management of arthritis.
    ``(e) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section such sums as may be necessary 
for each of fiscal years 2005 through 2009.

``SEC. 315B. STATE ARTHRITIS CONTROL AND PREVENTION PROGRAMS.

    ``(a) In General.--The Secretary shall award grants to eligible 
entities to provide support for comprehensive arthritis control and 
prevention programs and to enable such entities to provide public 
health surveillance, prevention, and control activities related to 
arthritis and other rheumatic diseases.
    ``(b) Eligibility.--To be eligible to receive a grant under this 
section, an entity shall be a State or Indian tribe.
    ``(c) Application.--To be eligible to receive a grant under this 
section, an entity shall submit to the Secretary an application at such 
time, in such manner, and containing such agreements, assurances, and 
information as the Secretary may require, including a comprehensive 
arthritis control and prevention plan that--
            ``(1) is developed with the advice of stakeholders from the 
        public, private, and nonprofit sectors that have expertise 
        relating to arthritis control, prevention, and treatment that 
        increase the quality of life and decrease the level of 
        disability;
            ``(2) is intended to reduce the morbidity of arthritis, 
        with priority on preventing and controlling arthritis in at-
        risk populations and reducing disparities in arthritis 
        prevention, diagnosis, management, and quality of care in 
        underserved populations;
            ``(3) describes the arthritis-related services and 
        activities to be undertaken or supported by the entity; and
            ``(4) is developed in a manner that is consistent with the 
        National Arthritis Action Plan or a subsequent strategic plan 
        designated by the Secretary.
    ``(d) Use of Funds.--An eligible entity shall use amounts received 
under a grant awarded under subsection (a) to conduct, in a manner 
consistent with the comprehensive arthritis control and prevention plan 
submitted by the entity in the application under subsection (c)--
            ``(1) public health surveillance and epidemiological 
        activities relating to the prevalence of arthritis and 
        assessment of disparities in arthritis prevention, diagnosis, 
        management, and care;
            ``(2) public information and education programs; and
            ``(3) education, training, and clinical skills improvement 
        activities for health professionals, including allied health 
        personnel.
    ``(e) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section such sums as may be necessary 
for each of fiscal years 2005 through 2009.

``SEC. 315C. COMPREHENSIVE ARTHRITIS ACTION GRANTS.

    ``(a) In General.--The Secretary shall award grants on a 
competitive basis to eligible entities to enable such eligible entities 
to assist in the implementation of a national strategy for arthritis 
control and prevention.
    ``(b) Eligibility.--To be eligible to receive a grant under this 
section, an entity shall be a national public or private nonprofit 
entity.
    ``(c) Application.--To be eligible to receive a grant under this 
section, an entity shall submit to the Secretary an application at such 
time, in such manner, and containing such agreements, assurances, and 
information as the Secretary may require, including a description of 
how funds received under a grant awarded under this section will--
            ``(1) supplement or fulfill unmet needs identified in the 
        comprehensive arthritis control and prevention plan of a State 
        or Indian tribe;
            ``(2) otherwise help achieve the goals of the National 
        Arthritis Action Plan or a subsequent strategic plan designated 
        by the Secretary.
    ``(d) Priority.--In awarding grants under this section, the 
Secretary shall give priority to eligible entities submitting 
applications proposing to carry out programs for controlling and 
preventing arthritis in at-risk populations or reducing disparities in 
underserved populations.
    ``(e) Use of Funds.--An eligible entity shall use amounts received 
under a grant awarded under subsection (a) for 1 or more of the 
following purposes:
            ``(1) To expand the availability of physical activity 
        programs designed specifically for people with arthritis.
            ``(2) To provide awareness education to patients, family 
        members, and health care providers, to help such individuals 
        recognize the signs and symptoms of arthritis, and to address 
        the control and prevention of arthritis.
            ``(3) To decrease long-term consequences of arthritis by 
        making information available to individuals with regard to the 
        self-management of arthritis.
            ``(4) To provide information on nutrition education 
        programs with regard to preventing or mitigating the impact of 
        arthritis.
    ``(f) 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 such grant that includes an 
analysis of increased utilization and benefit of public health programs 
relevant to the activities described in the appropriate provisions of 
subsection (e).
    ``(g) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section such sums as may be necessary 
for each of fiscal years 2005 through 2009.

``SEC. 315D. NATIONAL ARTHRITIS EDUCATION AND OUTREACH.

    ``(a) In General.--The Secretary shall coordinate a national 
education and outreach program to support, develop, and implement 
education initiatives and outreach strategies appropriate for arthritis 
and other rheumatic diseases.
    ``(b) Initiatives and Strategies.--Initiatives and strategies 
implemented under the program described in paragraph (1) may include 
public awareness campaigns, public service announcements, and community 
partnership workshops, as well as programs targeted at businesses and 
employers, managed care organizations, and health care providers.
    ``(c) Priority.--In carrying out subsection (a), the Secretary--
            ``(1) may emphasize prevention, early diagnosis, and 
        appropriate management of arthritis, and opportunities for 
        effective patient self-management; and
            ``(2) shall give priority to reaching high-risk or 
        underserved populations.
    ``(d) Collaboration.--In carrying out this section, the Secretary 
shall consult and collaborate with stake-holders from the public, 
private, and nonprofit sectors with expertise relating to arthritis 
control, prevention, and treatment.
    ``(e) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section such sums as may be necessary 
for each of fiscal years 2005 through 2009.''.

SEC. 4. EXPANSION AND COORDINATION OF ACTIVITIES OF THE NATIONAL 
              INSTITUTES OF HEALTH WITH RESPECT TO RESEARCH ON 
              ARTHRITIS.

    Title IV of the Public Health Service Act (42 U.S.C. 281 et seq.) 
is amended by inserting after section 439 the following:

``SEC. 439A. ARTHRITIS AND RHEUMATIC DISEASES INTERAGENCY COORDINATING 
              COMMITTEE.

    ``(a) In General.--
            ``(1) Establishment.--The Secretary shall establish an 
        Arthritis and Rheumatic Diseases Interagency Coordinating 
        Committee (referred to in this section as the `Coordinating 
        Committee').
            ``(2) Duties.--The coordinating committee established under 
        paragraph (1) shall--
                    ``(A) provide for the improved coordination of the 
                research activities of all the national research 
                institutes relating to arthritis and rheumatic 
                diseases; and
                    ``(B) provide for full and regular communication 
                and exchange of information necessary to maintain 
                adequate coordination across all Federal health 
                programs and activities related to arthritis and 
                rheumatic diseases.
    ``(b) Arthritis and Rheumatic Diseases Interagency Coordinating 
Committee.--
            ``(1) Composition.--The Coordinating Committee shall 
        consist of members, appointed by the Secretary, of which--
                    ``(A) \2/3\ of such members shall represent 
                governmental agencies, including--
                            ``(i) the directors of each of the national 
                        research institutes and divisions involved in 
                        research regarding arthritis and rheumatic 
                        diseases (or the directors' respective 
                        designees); and
                            ``(ii) representatives of other Federal 
                        departments and agencies (as determined 
                        appropriate by the Secretary) whose programs 
                        involve health functions or responsibilities 
                        relevant to arthritis and rheumatic diseases, 
                        including the Centers for Disease Control and 
                        Prevention, the Health Resources and Services 
                        Administration, and the Food and Drug 
                        Administration; and
                    ``(B) \1/3\ of such members shall be public 
                members, including a broad cross section of persons 
                affected by arthritis, researchers, clinicians, and 
                representatives of voluntary health agencies, who--
                            ``(i) shall serve for a term of 3 years; 
                        and
                            ``(ii) may serve for an unlimited number of 
                        terms if reappointed.
            ``(2) Chairperson.--
                    ``(A) Appointment.--The Chairperson of the 
                Coordinating Committee (referred to in this subsection 
                as the `Chairperson') shall be appointed by and be 
                directly responsible to the Secretary.
                    ``(B) Duties.--The Chairperson shall--
                            ``(i) serve as the principal advisor to the 
                        Secretary, the Assistant Secretary for Health, 
                        and the Director of NIH on matters relating to 
                        arthritis and rheumatic diseases; and
                            ``(ii) provide advice to the Director of 
                        the Centers for Disease Control and Prevention, 
                        the Commissioner of Food and Drugs, and the 
                        heads of other relevant Federal agencies, on 
                        matters relating to arthritis and rheumatic 
                        diseases.
            ``(3) Administrative support; meetings.--
                    ``(A) Administrative support.--The Secretary shall 
                provide necessary and appropriate administrative 
                support to the Coordinating Committee.
                    ``(B) Meetings.--The Coordinating Committee shall 
                meet on a regular basis as determined by the Secretary, 
                in consultation with the Chairperson.
    ``(c) Arthritis and Rheumatic Diseases Summit.--
            ``(1) In general.--Not later than 1 year after the date of 
        enactment of the Arthritis Prevention, Control, and Cure Act of 
        2004, the Coordinating Committee shall convene a summit of 
        researchers, public health professionals, representatives of 
        voluntary health agencies, representatives of academic 
        institutions, and Federal and State policymakers, to provide a 
        detailed overview of current research activities at the 
        National Institutes of Health, as well as to discuss and 
        solicit input related to potential areas of collaboration 
        between the National Institutes of Health and other Federal 
        health agencies, including the Centers for Disease Control and 
        Prevention, the Agency for Healthcare Research and Quality, and 
        the Health Resources and Services Administration, related to 
        research, prevention, and treatment of arthritis and rheumatic 
        diseases.
            ``(2) Summit details.--The summit developed under paragraph 
        (1) shall focus on--
                    ``(A) a broad range of research activities relating 
                to biomedical, epidemiological, psychosocial, and 
                rehabilitative issues, including studies of the impact 
                of the diseases described in paragraph (1) in rural and 
                underserved communities;
                    ``(B) clinical research for the development and 
                evaluation of new treatments, including new biological 
                agents;
                    ``(C) translational research on evidence-based and 
                cost-effective best practices in the treatment, 
                prevention, and management of the disease;
                    ``(D) information and education programs for health 
                care professionals and the public;
                    ``(E) priorities among the programs and activities 
                of the various Federal agencies regarding such 
                diseases; and
                    ``(F) challenges and opportunities for scientists, 
                clinicians, patients, and voluntary organizations.
    ``(d) Report to Congress.--Not later than 180 days after the 
convening of the Arthritis and Rheumatic Diseases Summit under 
subsection (c)(1), the Director of NIH shall prepare and submit a 
report to Congress that includes proceedings from the summit and a 
description of arthritis research, education, and other activities that 
are conducted or supported through the national research institutes.
    ``(e) Public Information.--The Coordinating Committee shall make 
readily available to the public information about the research, 
education, and other activities relating to arthritis and other 
rheumatic diseases, conducted or supported by the National Institutes 
of Health.
    ``(f) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as may be necessary for each of fiscal years 
2005 through 2009 to carry out this section.''.

SEC. 5. EXPANSION, INTENSIFICATION, AND INNOVATION OF RESEARCH AND 
              PUBLIC HEALTH ACTIVITIES RELATED TO JUVENILE ARTHRITIS.

    (a) Juvenile Arthritis Initiative Through the Director of the 
National Institutes of Health.--Part A of title IV of the Public Health 
Service Act (42 U.S.C. 281 et seq.) is amended by adding at the end the 
following:

``SEC. 404H. JUVENILE ARTHRITIS INITIATIVE THROUGH THE DIRECTOR OF THE 
              NATIONAL INSTITUTES OF HEALTH.

    ``(a) Expansion and Intensification of Activities.--
            ``(1) In general.--The Director of NIH, in coordination 
        with the Director of the National Institute of Arthritis and 
        Musculoskeletal and Skin Diseases, and the directors of the 
        other national research institutes, as appropriate, shall 
        expand and intensify programs of the National Institutes of 
        Health with respect to research and related activities 
        concerning various forms of juvenile arthritis.
            ``(2) Coordination.--The directors referred to in paragraph 
        (1) shall jointly coordinate the programs referred to in such 
        paragraph and consult with additional Federal officials, 
        voluntary health associations, medical professional societies, 
        and private entities as appropriate.
    ``(b) Planning Grants and Contracts for Innovative Research in 
Juvenile Arthritis.--
            ``(1) In general.--In carrying out subsection (a)(1) the 
        Director of NIH shall award planning grants or contracts for 
        the establishment of new research programs, or enhancement of 
        existing research programs, that focus on juvenile arthritis.
            ``(2) Research.--
                    ``(A) Types of research.--In carrying out this 
                subsection, the Secretary shall encourage research that 
                focus on genetics, on the development of biomarkers, 
                and on pharmacological and other therapies.
                    ``(B) Priority.--In awarding planning grants or 
                contracts under paragraph (1), the Director of NIH may 
                give priority to collaborative partnerships, which may 
                include academic health centers, private sector 
                entities, and nonprofit organizations.
    ``(c) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as may be necessary for each of fiscal years 
2005 through 2009 to carry out this section. Such authorization shall 
be in addition to any authorization of appropriations under any other 
provision of law to carry out juvenile arthritis activities or other 
arthritis-related research.''.
    (b) Public Health and Surveillance Activities Related to Juvenile 
Arthritis at the Centers for Disease Control and Prevention.--Part B of 
title III of the Public Health Service Act (42 U.S.C. 243 et seq.) is 
amended by inserting after section 320A the following:

``SEC. 320B. SURVEILLANCE AND RESEARCH REGARDING JUVENILE ARTHRITIS.

    ``(a) In General.--The Secretary, acting through the Director of 
the Centers for Disease Control and Prevention, may award grants to and 
enter into cooperative agreements with public or nonprofit private 
entities for the collection, analysis, and reporting of data on 
juvenile arthritis.
    ``(b) Technical Assistance.--In awarding grants and entering into 
agreements under subsection (a), the Secretary may provide direct 
technical assistance in lieu of cash.
    ``(c) Coordination With NIH.--The Secretary shall ensure that 
epidemiological and other types of information obtained under 
subsection (a) is made available to the National Institutes of Health.
    ``(d) Creation of a National Juvenile Arthritis Patient Registry.-- 
The Secretary, acting through the Director of the Centers for Disease 
Control and Prevention and in collaboration with a national voluntary 
health organization with experience serving the juvenile arthritis 
population as well as the full spectrum of arthritis-related 
conditions, shall support the development of a National Juvenile 
Arthritis Patient Registry to collect specific data for follow-up 
studies regarding the prevalence and incidence of juvenile arthritis, 
as well as capturing information on evidence-based health outcomes 
related to specific therapies and interventions.
    ``(e) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as may be necessary to carry out this 
section.''.

SEC. 6. INVESTMENT IN TOMORROW'S PEDIATRIC RHEUMATOLOGISTS.

    (a) In General.--Part Q of title III of the Public Health Service 
Act (42 U.S.C. 280h et seq.) is amended by adding at the end the 
following:

``SEC. 399AA. INVESTMENT IN TOMORROW'S PEDIATRIC RHEUMATOLOGISTS.

    ``(a) Enhanced Support.--In order to ensure an adequate future 
supply of pediatric rheumatologists, the Secretary, in consultation 
with the Administrator of the Health Resources and Services 
Administration, shall support activities that provide for--
            ``(1) an increase in the number and size of institutional 
        training grants awarded to institutions to support pediatric 
        rheumatology training; and
            ``(2) an expansion of public-private partnerships to 
        encourage academic institutions, private sector entities, and 
        health agencies to promote educational training and fellowship 
        opportunities for pediatric rheumatologists.
    ``(b) Authorization.--There are authorized to be appropriated such 
sums as may be necessary for each of fiscal years 2005 through 2009 to 
carry out this section.''.
    (b) Pediatric Loan Repayment Program.--Part Q of title III of the 
Public Health Service Act (42 U.S.C. 280h et seq.), as amended by 
subsection (a), is further amended by adding at the end the following:

``SEC. 399BB. PEDIATRIC RHEUMATOLOGY LOAN REPAYMENT PROGRAM.

    ``(a) In General.--The Secretary, in consultation with the 
Administrator of the Health Resources and Services Administration, may 
establish a pediatric rheumatology loan repayment program.
    ``(b) Program Administration.--Through the program established 
under subsection (a), the Secretary shall--
            ``(1) enter into contracts with qualified health 
        professionals who are pediatric rheumatologists under which--
                    ``(A) such professionals agree to provide health 
                care in an area with a shortage of pediatric 
                rheumatologists; and
                    ``(B) the Federal Government agrees to repay, for 
                each year of such service, not more than $25,000 of the 
                principal and interest of the educational loans of such 
                professionals; and
            ``(2) in addition to making payments under paragraph (1) on 
        behalf of an individual, make payments to the individual for 
        the purpose of providing reimbursement for tax liability 
        resulting from the payments made under paragraph (1), in an 
        amount equal to 39 percent of the total amount of the payments 
        made for the taxable year involved.
    ``(c) Funding.--
            ``(1) In general.--For the purpose of carrying out this 
        section, the Secretary may reserve, from amounts appropriated 
        for the Health Resources and Services Administration for the 
        fiscal year involved, such amounts as the Secretary determines 
        to be appropriate.
            ``(2) Availability of funds.--Amounts made available to 
        carry out this section shall remain available until the 
        expiration of the second fiscal year beginning after the fiscal 
        year for which such amounts were made available.''.

SEC. 7. CAREER DEVELOPMENT AWARDS IN PEDIATRIC RHEUMATOLOGY.

    Part G of title IV of the Public Health Service Act (42 U.S.C. 288 
et seq.) is amended--
            (1) by redesignating section 487F (as added by Public Law 
        106-505), as section 487G;
            (2) by inserting after section 487G (as so redesignated) 
        the following:

``SEC. 487H. CAREER DEVELOPMENT AWARDS IN PEDIATRIC RHEUMATOLOGY.

    ``(a) In General.--The Secretary, in consultation with the Director 
of NIH, may establish a program to increase the number of career 
development awards for health professionals who intend to build careers 
in clinical and translational research relating to pediatric 
rheumatology.
    ``(b) Authorization of Appropriations.--There are appropriated such 
sums as may be necessary to carry out this section.''.

SEC. 8. GENERAL ACCOUNTING OFFICE STUDY OF ARTHRITIS AND THE WORKPLACE.

    (a) Study and Report.--Not later than 3 years after the date of 
enactment of this Act, the Comptroller General of the United States 
shall conduct a study on the economic impact of arthritis in the 
workplace, and submit a report to the appropriate committees of 
Congress containing the results of the study.
    (b) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as may be necessary to carry out this section.
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