[House Report 116-530]
[From the U.S. Government Publishing Office]


116th Congress  }                                             {    Report
                          HOUSE OF REPRESENTATIVES
 2d Session     }                                             {   116-530

======================================================================



 
        SCHOOL-BASED ALLERGIES AND ASTHMA MANAGEMENT PROGRAM ACT

                                _______
                                

 September 22, 2020.--Committed to the Committee of the Whole House on 
            the State of the Union and ordered to be printed

                                _______
                                

 Mr. Pallone, from the Committee on Energy and Commerce, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 2468]

    The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 2468) to amend the Public Health Service Act to 
increase the preference given, in awarding certain allergies 
and asthma-related grants, to States that require certain 
public schools to have allergies and asthma management 
programs, and for other purposes, having considered the same, 
reports favorably thereon with an amendment and recommends that 
the bill as amended do pass.

                                CONTENTS

                                                                   Page
  I. Purpose and Summary..............................................2
 II. Background and Need for the Legislation..........................3
III. Committee Hearings...............................................4
 IV. Committee Consideration..........................................5
  V. Committee Votes..................................................5
 VI. Oversight Findings...............................................5
VII. New Budget Authority, Entitlement Authority, and Tax Expenditures5
VIII.Federal Mandates Statement.......................................6

 IX. Statement of General Performance Goals and Objectives............6
  X. Duplication of Federal Programs..................................6
 XI. Committee Cost Estimate..........................................6
XII. Earmarks, Limited Tax Benefits, and Limited Tariff Benefits......6
XIII.Advisory Committee Statement.....................................6

XIV. Applicability to Legislative Branch..............................6
 XV. Section-by-Section Analysis of the Legislation...................6
XVI. Changes in Existing Law Made by the Bill, as Reported............7

    The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``School-Based Allergies and Asthma 
Management Program Act''.

SEC. 2. ADDITIONAL PREFERENCE TO CERTAIN STATES THAT REQUIRE CERTAIN 
                    PUBLIC SCHOOLS TO HAVE ALLERGIES AND ASTHMA 
                    MANAGEMENT PROGRAMS.

  Section 399L(d) of the Public Health Service Act (42 U.S.C. 280g(d)) 
is amended--
          (1) in paragraph (1)(F)--
                  (A) by redesignating clauses (i), (ii), and (iii) as 
                subclauses (I), (II), and (III), respectively, and 
                moving each of such subclauses (as so redesignated) 2 
                ems to the right;
                  (B) by striking ``epinephrine.--In determining'' and 
                inserting ``epinephrine or school comprehensive 
                allergies and asthma management program.--
                          ``(i) In general.--In determining'';
                  (C) by striking ``in the State--'' and inserting ``in 
                the State satisfy the criteria described in clause (ii) 
                or clause (iii).
                          ``(ii) Criteria for school personnel 
                        administration of epinephrine.--For purposes of 
                        clause (i), the criteria described in this 
                        clause, with respect to each public elementary 
                        school and secondary school in the State, are 
                        that each such school--''; and
                  (D) by adding at the end the following new clause:
                          ``(iii) Criteria for school comprehensive 
                        allergies and asthma management program.--For 
                        purposes of clause (i), the criteria described 
                        in this clause, with respect to each public 
                        elementary school and secondary school in the 
                        State, are that each such school--
                                  ``(I) has in place a plan for having 
                                on the premises of the school during 
                                all operating hours of the school a 
                                school nurse or one or more other 
                                individuals who are designated by the 
                                principal (or other appropriate 
                                administrative staff) of the school to 
                                direct and apply the program described 
                                in subclause (II) on a voluntary basis 
                                outside their scope of employment; and
                                  ``(II) has in place, under the 
                                direction of a school nurse or other 
                                individual designated under subclause 
                                (I), a comprehensive school-based 
                                allergies and asthma management program 
                                that includes--
                                          ``(aa) a method to identify 
                                        all students of such school 
                                        with a diagnosis of allergies 
                                        and asthma;
                                          ``(bb) an individual student 
                                        allergies and asthma action 
                                        plan for each student of such 
                                        school with a diagnosis of 
                                        allergies and asthma;
                                          ``(cc) allergies and asthma 
                                        education for school staff who 
                                        are directly responsible for 
                                        students who have been 
                                        identified as having allergies 
                                        or asthma, such as education 
                                        regarding basics, management, 
                                        trigger management, and 
                                        comprehensive emergency 
                                        responses with respect to 
                                        allergies and asthma;
                                          ``(dd) efforts to reduce the 
                                        presence of environmental 
                                        triggers of allergies and 
                                        asthma; and
                                          ``(ee) a system to support 
                                        students with a diagnosis of 
                                        allergies or asthma through 
                                        coordination with family 
                                        members of such students, 
                                        primary care providers of such 
                                        students, primary asthma or 
                                        allergy care providers of such 
                                        students, and others as 
                                        necessary.''; and
          (2) in paragraph (3)(E)--
                  (A) in the matter preceding clause (i), by inserting 
                ``, such as the school nurse'' after ``individual''; 
                and
                  (B) in clause (i), by inserting ``school nurse or'' 
                before ``principal''.

                         I. Purpose and Summary

    H.R. 2468, the ``School-Based Allergies and Asthma 
Management Program Act'', was introduced on May 2, 2019, by 
Representatives Steny H. Hoyer (D-MD) and David P. Roe (R-TN). 
H.R. 2468 amends the Public Health Service Act to add an 
additional preference for grants to those States that have 
additional access to certain healthcare professionals and 
programs. To be eligible for this preference, States would have 
to require: (1) a school nurse or other trained personnel on 
school premises during school operating hours; (2) a school-
based allergies and asthma program, including a method to 
identify all students in the school with a diagnosis of 
allergies and asthma; (3) an individual student allergies and 
asthma action plan for each student with a diagnosis of 
allergies and asthma; (4) an education program for staff about 
allergies and asthma; (5) protocols in place to reduce 
environmental triggers of allergies and asthma; and (6) a 
coordinated support system for students.

                II. Background and Need for Legislation

    Established in 1999, the Centers for Disease Control and 
Prevention's (CDC) National Asthma Control Program (NACP) was 
created to provide aid to the millions of Americans with asthma 
or other anaphylaxis-related illnesses, such as allergies.\1\ 
The program has improved asthma treatment, management, and 
control in the U.S. by reducing the number of deaths, 
hospitalizations, emergency department visits, school days or 
workdays missed, and limitations on activity due to asthma and 
allergies.\2\
---------------------------------------------------------------------------
    \1\Centers for Disease Control and Prevention, CDC's National 
Asthma Control Program (www.cdc.gov/asthma/nacp.htm) (accessed Sep. 21, 
2020).
    \2\See note 1.
---------------------------------------------------------------------------
    Today, the CDC provides financial assistance to health 
departments in 24 States and Puerto Rico to ensure the 
availability of and access to guidelines-based medical 
management and pharmacotherapy for those with asthma, as well 
as offers funding to State programs and national organizations, 
promoting asthma quality measures, and informing policymakers 
about the burden of asthma.\3\
---------------------------------------------------------------------------
    \3\Id.
---------------------------------------------------------------------------
    More than eight percent of children in the United States 
under the age of 18 live with asthma.\4\ For these children and 
children with respiratory issues caused by asthma, access to 
appropriate treatment and trained personnel can mean the 
difference between life and death in emergency situations. In 
2004, Congress authorized Children's Asthma Treatment Grants to 
expand access to medical care for children who live in areas 
with a high prevalence of asthma. Support from these grants 
helps to educate parents, children, and health providers on 
asthma treatment and symptom prevention, and decreases 
preventable trips to the emergency room.\5\ The law included a 
preference in awarding grants to States that allow students to 
self-administer epinephrine in schools under certain 
circumstances. In 2013, Congress amended the law to award an 
additional preference to States that allow trained personnel in 
schools to administer epinephrine.\6\
---------------------------------------------------------------------------
    \4\Centers for Disease Control and Prevention, Most Recent National 
Asthma Data (2019) (www.cdc.gov/asthma/
most_recent_national_asthma_data.htm).
    \5\P.L. 108-377.
    \6\P.L. 113-48.
---------------------------------------------------------------------------
    Asthma and allergies are still, however, a leading cause of 
school absenteeism for the more than six million American 
children suffering from these illnesses.\7\ As 25 percent of 
first-time anaphylactic reactions occur at school, it is 
critical that students experiencing an anaphylactic reaction 
have immediate access to emergency stock epinephrine at 
school.\8\ Further, research suggests that the majority of 
fatal food allergy reactions are triggered by food consumed 
outside one's home.\9\
---------------------------------------------------------------------------
    \7\Hatice S. Zahran, MD et al., Vital Signs: Asthma in Children--
United States, 2001-2016, Centers for Disease Control and Prevention 
(Feb. 6, 2018) (www.cdc.gov/mmwr/volumes/67/wr/
mm6705e1.htm?s_cid=mm6705e1_w#).
    \8\Food Allergy & Anaphylaxis Connection Team, Education: For 
School Personnel (www.foodallergyawareness.org/education/for-school-
personnel/for-school-personnel/) (accessed on Sep. 21, 2020).
    \9\Food Allergy Research & Education, Food Allergy Facts and 
Statistics for the U.S. (2020) (www.foodallergy.org/resources/facts-
and-statistics).
---------------------------------------------------------------------------
    In response, H.R. 2468 expands upon the current Children's 
Asthma Treatment Grant Program to include additional funding 
prioritization for States with comprehensive plans in place for 
school-based allergies and asthma management programs at all of 
the elementary and secondary schools, in addition to plans that 
maintain a school nurse or other trained personnel on the 
premises of those schools during all operating hours. According 
to the American Academy of Allergy, Asthma & Immunology, the 
most important strategy for ensuring children living with 
asthma and allergies can be safe in school is ensuring schools 
are implementing comprehensive management plans, including 
preparing school personnel to assist children experiencing an 
attack.\10\ H.R. 2468 supports schools in the development of 
allergies and asthma management plans. This type of preparation 
and management in schools not only will improve child health 
but will also ensure students are able to focus on learning.
---------------------------------------------------------------------------
    \10\American Academy of Allergy, Asthma & Immunology, School Tools: 
Allergy & Asthma Resources For Families, Clinicians And School Nurses 
(www.aaaai.org/conditions-and-treatments/school-tools) (accessed Sep. 
21, 2020).
---------------------------------------------------------------------------

                        III. Committee Hearings

    For the purposes of section 103(i) of H. Res. 6 of the 
116th Congress, the following hearing was used to develop or 
consider H.R. 2468.
    The Subcommittee on Health held a legislative hearing on 
January 8, 2020, entitled ``Legislation to Improve Americans' 
Health Care Coverage and Outcomes'' to consider H.R. 2468, the 
``School-Based Allergies and Asthma Act''. The Subcommittee 
received testimony from the following witnesses:

Panel I:

           Lee Beers, M.D., President-Elect, American 
        Academy of Pediatrics
           Kenneth Mendez, President and Chief 
        Executive Officer, Asthma and Allergy Foundation of 
        America
           Stephanie Zarecky, Mother of Scarlett 
        Pauley, Ambassador Program and Public Relations 
        Manager, SUDC Foundation

Panel II:

           Matthew Cooper, M.D., Director, Kidney and 
        Pancreas Transplantation, Medical Director, Transplant 
        QAPI, Medstar Georgetown Transplant Institute, 
        Professor of Surgery, Georgetown University School of 
        Medicine
           Kevin Koser, Patient Advocate
           Fred Riccardi, President Medicare Rights 
        Center IV.

                        Committee Consideration

    Representatives Hoyer (D-MD) and Roe (R-TN) introduced H.R. 
2468, the ``School-Based Allergies and Asthma Management 
Program Act'', on May 2, 2019, and the bill was referred to the 
Committee on Energy and Commerce. The bill was then referred to 
the Subcommittee on Health on May 3, 2019. A legislative 
hearing was held on the bill on January 8, 2020.
    On March 11, 2020, the Subcommittee on Health met in open 
markup session, pursuant to notice, to consider H.R. 2468. 
During consideration of the bill, an amendment in the nature of 
a substitute offered by Ms. Eshoo of California was agreed to 
by a voice vote. The Subcommittee on Health then agreed to a 
motion by Ms. Eshoo, Chairwoman of the subcommittee, to forward 
favorably H.R. 2468, amended, to the full Committee on Energy 
and Commerce by a voice vote.
    On July 15, 2020, the full Committee met in virtual open 
markup session, pursuant to notice, to consider a committee 
print of the bill H.R. 2468, as amended by the Subcommittee on 
Health on March 11, 2020. There were no amendments offered to 
the committee print of H.R. 2468. Upon conclusion of 
consideration of the bill, the full Committee agreed to a 
motion on final passage by Mr. Pallone, Chairman of the 
committee, to order H.R. 2468 reported favorably to the House, 
as amended, by a voice vote, a quorum being present.

                           V. Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list each record vote 
on the motion to report legislation and amendments thereto. The 
Committee advises that there were no record votes taken on H.R. 
2468, including the motion for final passage of the bill.

                         VI. Oversight Findings

    Pursuant to clause 3(c)(1) of rule XIII and clause 2(b)(1) 
of rule X of the Rules of the House of Representatives, the 
oversight findings and recommendations of the Committee are 
reflected in the descriptive portion of the report.

 VII. New Budget Authority, Entitlement Authority, and Tax Expenditures

    Pursuant to 3(c)(2) of rule XIII of the Rules of the House 
of Representatives, the Committee adopts as its own the 
estimate of new budget authority, entitlement authority, or tax 
expenditures or revenues contained in the cost estimate 
prepared by the Director of the Congressional Budget Office 
pursuant to section 402 of the Congressional Budget Act of 
1974.
    The Committee has requested but not received from the 
Director of the Congressional Budget Office a statement as to 
whether this bill contains any new budget authority, spending 
authority, credit authority, or an increase or decrease in 
revenues or tax expenditures.

                    VIII. Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates prepared by the Director of the Congressional Budget 
Office pursuant to section 423 of the Unfunded Mandates Reform 
Act.

       IX. Statement of General Performance Goals and Objectives

    Pursuant to clause 3(c)(4) of rule XIII, the general 
performance goal or objective of this legislation is to improve 
outcomes for youth with allergies and asthma by increasing the 
preference given, in awarding certain allergies and asthma-
related grants, to States that require certain public schools 
to have allergies and asthma management programs and trained 
personnel on school grounds during all operating hours.

                   X. Duplication of Federal Programs

    Pursuant to clause 3(c)(5) of rule XIII, no provision of 
H.R. 2468 is known to be duplicative of another Federal 
program, including any program that was included in a report to 
Congress pursuant to section 21 of Public Law 111-139 or the 
most recent Catalog of Federal Domestic Assistance.

                      XI. Committee Cost Estimate

    Pursuant to clause 3(d)(1) of rule XIII, the Committee 
adopts as its own the cost estimate prepared by the Director of 
the Congressional Budget Office pursuant to section 402 of the 
Congressional Budget Act of 1974.

    XII. Earmarks, Limited Tax Benefits, and Limited Tariff Benefits

    Pursuant to clause 9(e), 9(f), and 9(g) of rule XXI, the 
Committee finds that H.R. 2468 contains no earmarks, limited 
tax benefits, or limited tariff benefits.

                   XIII. Advisory Committee Statement

    No advisory committee within the meaning of section 5(b) of 
the Federal Advisory Committee Act was created by this 
legislation.

                XIV. Applicability to Legislative Branch

    The Committee finds that the legislation does not relate to 
the terms and conditions of employment or access to public 
services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

           XV. Section-by-Section Analysis of the Legislation


Section 1. Short title

    Section 1 designates that the short title may be cited as 
the ``School-Based Allergies and Asthma Management Program 
Act''.

Sec. 2. Additional preference to certain States that require certain 
        public schools to have allergies and asthma management programs

    Section 2 amends section 399(L)(d) of the Public Health 
Service Act to direct the Secretary to provide an additional 
preference for States that certify each public elementary and 
secondary school in the State has a plan for having a school 
nurse or other trained personnel on the premises of the school 
during operating hours to direct and apply a comprehensive 
school-based allergies and asthma management program on a 
voluntary basis. The comprehensive school-based allergies and 
asthma management program in place under the direction of a 
school nurse in each school must include a method to identify 
all students in the school with an allergy or asthma diagnosis; 
an individualized action plan for each student with such a 
diagnosis; allergies and asthma education for certain staff 
responsible for students with allergies and asthma; efforts to 
reduce the presence of environmental triggers of allergies and 
asthma; and a system to support students with these diagnoses 
through coordination with families, primary care providers, and 
others as necessary.
    Section 2 also amends the program to include school nurses 
in the definition of ``trained personnel'' within an elementary 
or secondary school, as well as including a school nurse as an 
authority in designating who may administer epinephrine on a 
voluntary basis outside their scope of employment.

       XVI. Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italics, and existing law in which no 
change is proposed is shown in roman):

                       PUBLIC HEALTH SERVICE ACT



           *       *       *       *       *       *       *
TITLE III--GENERAL POWERS AND DUTIES OF PUBLIC HEALTH SERVICE

           *       *       *       *       *       *       *


                      PART P--ADDITIONAL PROGRAMS

SEC. 399L. CHILDREN'S ASTHMA TREATMENT GRANTS PROGRAM.

  (a) Authority To Make Grants.--
          (1) In general.--In addition to any other payments 
        made under this Act or title V of the Social Security 
        Act, the Secretary shall award grants to eligible 
        entities to carry out the following purposes:
                  (A) 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.
                  (B) 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 treat asthma and prevent its 
                exacerbations.
                  (C) 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 
                management of asthma.
                  (D) 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.
          (2) Certain projects.--In making grants under 
        paragraph (1), the Secretary may make grants designed 
        to develop and expand the following projects:
                  (A) Projects to provide comprehensive asthma 
                services to children in accordance with the 
                guidelines of the National Asthma Education and 
                Prevention Program (through the National Heart, 
                Lung and Blood Institute), including access to 
                care and treatment for asthma in a community-
                based setting.
                  (B) Projects to 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) Projects to conduct 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.
          (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 or suspected high 
                prevalence of childhood asthma or high asthma-
                related mortality or high rate of 
                hospitalization or emergency room visits for 
                asthma (relative to the average asthma 
                prevalence 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, claims data under title XIX 
                or XXI of the Social Security Act, 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.--For purposes of 
        this section, the term ``eligible entity'' means a 
        public or nonprofit private entity (including a State 
        or political subdivision of a State), or a consortium 
        of any of such entities.
  (b) 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 title V, XIX, or XXI of the Social 
        Security Act; 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 of such Act;
                  (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).
  (c) 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.
  (d) Preference for States That Allow Students to Self-
Administer Medication to Treat Asthma and Anaphylaxis.--
          (1) Preference.--The Secretary, in making any grant 
        under this section or any other grant that is asthma-
        related (as determined by the Secretary) to a State, 
        shall give preference to any State that satisfies the 
        following:
                  (A) In general.--The State must require that 
                each public elementary school and secondary 
                school in that State will grant to any student 
                in the school an authorization for the self-
                administration of medication to treat that 
                student's asthma or anaphylaxis, if--
                          (i) a health care practitioner 
                        prescribed the medication for use by 
                        the student during school hours and 
                        instructed the student in the correct 
                        and responsible use of the medication;
                          (ii) the student has demonstrated to 
                        the health care practitioner (or such 
                        practitioner's designee) and the school 
                        nurse (if available) the skill level 
                        necessary to use the medication and any 
                        device that is necessary to administer 
                        such medication as prescribed;
                          (iii) the health care practitioner 
                        formulates a written treatment plan for 
                        managing asthma or anaphylaxis episodes 
                        of the student and for medication use 
                        by the student during school hours; and
                          (iv) the student's parent or guardian 
                        has completed and submitted to the 
                        school any written documentation 
                        required by the school, including the 
                        treatment plan formulated under clause 
                        (iii) and other documents related to 
                        liability.
                  (B) Scope.--An authorization granted under 
                subparagraph (A) must allow the student 
                involved to possess and use his or her 
                medication--
                          (i) while in school;
                          (ii) while at a school-sponsored 
                        activity, such as a sporting event; and
                          (iii) in transit to or from school or 
                        school-sponsored activities.
                  (C) Duration of authorization.--An 
                authorization granted under subparagraph (A)--
                          (i) must be effective only for the 
                        same school and school year for which 
                        it is granted; and
                          (ii) must be renewed by the parent or 
                        guardian each subsequent school year in 
                        accordance with this subsection.
                  (D) Backup medication.--The State must 
                require that backup medication, if provided by 
                a student's parent or guardian, be kept at a 
                student's school in a location to which the 
                student has immediate access in the event of an 
                asthma or anaphylaxis emergency.
                  (E) Maintenance of information.--The State 
                must require that information described in 
                subparagraphs (A)(iii) and (A)(iv) be kept on 
                file at the student's school in a location 
                easily accessible in the event of an asthma or 
                anaphylaxis emergency.
                  (F) School personnel administration of 
                [epinephrine.--] [In determining] epinephrine 
                or school comprehensive allergies and asthma 
                management program._
                          (i) In general.--In determining the 
                        preference (if any) to be given to a 
                        State under this subsection, the 
                        Secretary shall give additional 
                        preference to a State that provides to 
                        the Secretary the certification 
                        described in subparagraph (G) and that 
                        requires that each public elementary 
                        school and secondary school [in the 
                        State--] in the State satisfy the 
                        criteria described in clause (ii) or 
                        clause (iii).
                          (ii) Criteria for school personnel 
                        administration of epinephrine.--For 
                        purposes of clause (i), the criteria 
                        described in this clause, with respect 
                        to each public elementary school and 
                        secondary school in the State, are that 
                        each such school--
                                  [(i)] (I) permits trained 
                                personnel of the school to 
                                administer epinephrine to any 
                                student of the school 
                                reasonably believed to be 
                                having an anaphylactic 
                                reaction;
                                  [(ii)] (II) maintains a 
                                supply of epinephrine in a 
                                secure location that is easily 
                                accessible to trained personnel 
                                of the school for the purpose 
                                of administration to any 
                                student of the school 
                                reasonably believed to be 
                                having an anaphylactic 
                                reaction; and
                                  [(iii)] (III) has in place a 
                                plan for having on the premises 
                                of the school during all 
                                operating hours of the school 
                                one or more individuals who are 
                                trained personnel of the 
                                school.
                          (iii) Criteria for school 
                        comprehensive allergies and asthma 
                        management program.--For purposes of 
                        clause (i), the criteria described in 
                        this clause, with respect to each 
                        public elementary school and secondary 
                        school in the State, are that each such 
                        school--
                                  (I) has in place a plan for 
                                having on the premises of the 
                                school during all operating 
                                hours of the school a school 
                                nurse or one or more other 
                                individuals who are designated 
                                by the principal (or other 
                                appropriate administrative 
                                staff) of the school to direct 
                                and apply the program described 
                                in subclause (II) on a 
                                voluntary basis outside their 
                                scope of employment; and
                                  (II) has in place, under the 
                                direction of a school nurse or 
                                other individual designated 
                                under subclause (I), a 
                                comprehensive school-based 
                                allergies and asthma management 
                                program that includes--
                                          (aa) a method to 
                                        identify all students 
                                        of such school with a 
                                        diagnosis of allergies 
                                        and asthma;
                                          (bb) an individual 
                                        student allergies and 
                                        asthma action plan for 
                                        each student of such 
                                        school with a diagnosis 
                                        of allergies and 
                                        asthma;
                                          (cc) allergies and 
                                        asthma education for 
                                        school staff who are 
                                        directly responsible 
                                        for students who have 
                                        been identified as 
                                        having allergies or 
                                        asthma, such as 
                                        education regarding 
                                        basics, management, 
                                        trigger management, and 
                                        comprehensive emergency 
                                        responses with respect 
                                        to allergies and 
                                        asthma;
                                          (dd) efforts to 
                                        reduce the presence of 
                                        environmental triggers 
                                        of allergies and 
                                        asthma; and
                                          (ee) a system to 
                                        support students with a 
                                        diagnosis of allergies 
                                        or asthma through 
                                        coordination with 
                                        family members of such 
                                        students, primary care 
                                        providers of such 
                                        students, primary 
                                        asthma or allergy care 
                                        providers of such 
                                        students, and others as 
                                        necessary.
                  (G) Civil liability protection law.--The 
                certification required in subparagraph (F) 
                shall be a certification made by the State 
                attorney general that the State has reviewed 
                any applicable civil liability protection law 
                to determine the application of such law with 
                regard to elementary and secondary school 
                trained personnel who may administer 
                epinephrine to a student reasonably believed to 
                be having an anaphylactic reaction and has 
                concluded that such law provides adequate civil 
                liability protection applicable to such trained 
                personnel. For purposes of the previous 
                sentence, the term ``civil liability protection 
                law'' means a State law offering legal 
                protection to individuals who give aid on a 
                voluntary basis in an emergency to an 
                individual who is ill, in peril, or otherwise 
                incapacitated.
          (2) Rule of construction.--Nothing in this subsection 
        creates a cause of action or in any other way increases 
        or diminishes the liability of any person under any 
        other law.
          (3) Definitions.--For purposes of this subsection:
                  (A) The terms ``elementary school'' and 
                ``secondary school'' have the meaning given to 
                those terms in section 8101 of the Elementary 
                and Secondary Education Act of 1965.
                  (B) The term ``health care practitioner'' 
                means a person authorized under law to 
                prescribe drugs subject to section 503(b) of 
                the Federal Food, Drug, and Cosmetic Act.
                  (C) The term ``medication'' means a drug as 
                that term is defined in section 201 of the 
                Federal Food, Drug, and Cosmetic Act and 
                includes inhaled bronchodilators and auto-
                injectable epinephrine.
                  (D) The term ``self-administration'' means a 
                student's discretionary use of his or her 
                prescribed asthma or anaphylaxis medication, 
                pursuant to a prescription or written direction 
                from a health care practitioner.
                  (E) The term ``trained personnel'' means, 
                with respect to an elementary or secondary 
                school, an individual, such as the school 
                nurse--
                          (i) who has been designated by the 
                        school nurse or principal (or other 
                        appropriate administrative staff) of 
                        the school to administer epinephrine on 
                        a voluntary basis outside their scope 
                        of employment;
                          (ii) who has received training in the 
                        administration of epinephrine; and
                          (iii) whose training in the 
                        administration of epinephrine meets 
                        appropriate medical standards and has 
                        been documented by appropriate 
                        administrative staff of the school.
  (e) Authorization of Appropriations.--For the purpose of 
carrying out this section, there are authorized to be 
appropriated such sums as may be necessary for each of the 
fiscal years 2001 through 2005.

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