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113th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 1st Session                                                    113-182

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



 
               SCHOOL ACCESS TO EMERGENCY EPINEPHRINE ACT

                                _______
                                

 July 30, 2013.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

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

                              R E P O R T

                        [To accompany H.R. 2094]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 2094) to amend the Public Health Service Act to 
increase the preference given, in awarding certain asthma-
related grants, to certain States (those allowing trained 
school personnel to administer epinephrine and meeting other 
related requirements), having considered the same, report 
favorably thereon without amendment and recommend that the bill 
do pass.

                                CONTENTS

                                                                   Page
Purpose and Summary..............................................     2
Background and Need for Legislation..............................     2
Hearings.........................................................     2
Committee Consideration..........................................     3
Committee Votes..................................................     3
Committee Oversight Findings.....................................     3
Statement of General Performance Goals and Objectives............     3
New Budget Authority, Entitlement Authority, and Tax Expenditures     3
Earmark, Limited Tax Benefits, and Limited Tariff Benefits.......     3
Committee Cost Estimate..........................................     3
Congressional Budget Office Estimate.............................     3
Federal Mandates Statement.......................................     4
Duplication of Federal Programs..................................     4
Disclosure of Directed Rule Makings..............................     5
Advisory Committee Statement.....................................     5
Applicability to Legislative Branch..............................     5
Section-by-Section Analysis of the Legislation...................     5
Changes in Existing Law Made by the Bill, as Reported............     5

                          Purpose and Summary

    H.R. 2094, the ``School Access to Emergency Epinephrine 
Act,'' was introduced on May 22, 2013, by Rep. Phil Roe (R-TN) 
and Rep. Steny Hoyer (D-MD) and subsequently referred to the 
Committee on Energy and Commerce.
    The legislation would amend the Public Health Service Act 
to give preference in awarding certain asthma grants to States 
that agree to establish school-based emergency epinephrine 
programs that meet specific requirements.

                  Background and Need for Legislation

    Nearly 6 million children have food allergies, and many of 
them have had severe reactions. A study in the Journal of 
Pediatrics suggests these rates are rising.\1\ Severe allergic 
reactions can lead to anaphylaxis, a systemic reaction that 
causes swelling that can obstruct airwaves and lead to death. 
According to the Centers for Disease Control and Prevention 
(CDC), more than 15% of school-aged children with food 
allergies have had a reaction at school where teachers and 
other school personnel may be unprepared to handle the 
emergency.\2\
---------------------------------------------------------------------------
    \1\http://pediatrics.aappublications.org/content/early/2011/06/16/
peds.2011-0204.abstract 
    \2\http://www.cdc.gov/healthyyouth/foodallergies/ 
---------------------------------------------------------------------------
    Epinephrine is the most effective treatment for 
anaphylaxis, and it can be administered simply and quickly 
using an epipen. Children who have had a severe allergic 
reaction often carry an epipen and self-medicate as needed. In 
2004, Congress enacted H.R. 2023, the ``Asthma Schoolchildren's 
Treatment and Health Management Act,'' which created the 
Children's Asthma Treatment Grants Program and authorized 
preferences for States that allow students to self-administer 
medication to treat asthma and anaphylaxis in accordance with 
specified requirements. The legislation did not address the 
needs of students who may have severe allergies, but have not 
been diagnosed.
    H.R. 2094, the ``School Access to Emergency Epinephrine 
Act,'' would amend the Children's Asthma Treatment Grants 
Program and other asthma programs administered by the 
Department of Health and Human Services (HHS) to aid schools in 
preparing to treat severe allergic reactions. The bill would 
give preference in awarding certain asthma-related grants to 
States that allow school personnel to administer epinephrine to 
a student in an emergency and meet other requirements. To 
receive the preference, States would have to certify that their 
civil liability laws provide adequate civil liability 
protection to school personnel who administer epinephrine in an 
emergency. School personnel would be required to have 
appropriate training. Schools would be required to have a plan 
in place for having at least one trained employee on site 
during school hours and to maintain a supply of epinephrine.

                                Hearings

    The Committee on Energy and Commerce has not held hearings 
on the legislation.

                        Committee Consideration

    On July 17, 2013, the full Committee met in open markup 
session and approved H.R. 2094 by unanimous consent.

                            Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list the record votes 
on the motion to report legislation and amendments thereto. A 
motion by Mr. Upton to order H.R. 2094, reported to the House, 
without amendment, was agreed to by unanimous consent. There 
were no record votes taken in connection with ordering H.R. 
2094 reported.

                      Committee Oversight Findings

    Pursuant to clause 3(c)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee has not held oversight 
or legislative hearings on this legislation.

         Statement of General Performance Goals and Objectives

    The goal of the legislation is to give preference in 
awarding certain asthma grants to States that allow trained 
school personnel to administer epinephrine in an emergency.

   New Budget Authority, Entitlement Authority, and Tax Expenditures

    In compliance with clause 3(c)(2) of rule XIII of the Rules 
of the House of Representatives, the Committee finds that H.R. 
2094, the ``School Access to Emergency Epinephrine Act'', would 
result in no new or increased budget authority, entitlement 
authority, or tax expenditures or revenues.

       Earmark, Limited Tax Benefits, and Limited Tariff Benefits

    In compliance with clause 9(e), 9(f), and 9(g) of rule XXI 
of the House of Representatives, the Committee finds that H.R. 
2094, the ``School Access to Emergency Epinephrine Act'' 
contains no earmarks, limited tax benefits, or limited tariff 
benefits.

                        Committee Cost Estimate

    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.

                  Congressional Budget Office Estimate

    Pursuant to clause 3(c)(3) of rule XIII of the Rules of the 
House of Representatives, the following is the cost estimate 
provided by the Congressional Budget Office pursuant to section 
402 of the Congressional Budget Act of 1974:

                                                     July 22, 2013.
Hon. Fred Upton,
Chairman, Committee on Energy and Commerce,
 House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 2094, the School 
Access to Emergency Epinephrine Act.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Santiago 
Vallinas.
            Sincerely,
                                              Douglas W. Elmendorf.
    Enclosure.

H.R. 2094--School Access to Emergency Epinephrine Act

    H.R. 2094 would authorize the Secretary of Health and Human 
Services, in awarding asthma-treatment grants, to give 
preference to states that require schools to:
           Maintain an emergency supply of epinephrine,
           Permit trained personnel of the school to 
        administer epinephrine, and
           Have a plan for ensuring trained personnel 
        are available to administer epinephrine during all 
        hours of the school day.
    In addition, to obtain the preference for grants under the 
bill, states would have to certify that their laws provide 
civil liability protection to school personnel that administer 
epinephrine.
    The bill would not change the purposes for which the 
Secretary makes asthma-related grants or the amount of funding 
available. CBO estimates that implementing H.R. 2094 would not 
have a significant impact on the federal budget. Enacting H.R. 
2094 would not affect direct spending or revenues; therefore, 
pay-as-you-go procedures do not apply.
    H.R. 2094 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act and 
would impose no costs on state, local, or tribal governments.
    The CBO staff contact for this estimate is Santiago 
Vallinas. The estimate was approved by Holly Harvey, Deputy 
Assistant Director for Budget Analysis.

                       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.

                    Duplication of Federal Programs

    No provision of H.R. 2094, the ``School Access to Emergency 
Epinephrine Act,'' establishes or reauthorizes a program of the 
Federal Government known to be duplicative of another Federal 
program, a program that was included in any report from the 
Government Accountability Office to Congress pursuant to 
section 21 of Public Law 111-139, or a program related to a 
program identified in the most recent Catalog of Federal 
Domestic Assistance.

                  Disclosure of Directed Rule Makings

    The Committee estimates that enacting H.R. 2094, the 
``School Access to Emergency Epinephrine Act,'' specifically 
would not direct specific rule making within the meaning of 5 
U.S.C. 551.

                      Advisory Committee Statement

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

                  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.

             Section-by-Section Analysis of the Legislation


Section 1. Short title

    This Act may be cited as the ``School Access to Emergency 
Epinephrine Act.''

Section 2. Additional preference to pertain States that allow trained 
        school personnel to administer epinephrine

    Section 2 would amend the Children's Asthma Treatment 
Grants Program and other asthma programs administered by HHS to 
aid in preparing schools to treat severe allergic reactions in 
emergency situations. The section would provide a preference in 
awarding certain asthma-related grants to States that allow 
school personnel to administer epinephrine to a student of the 
school reasonably believed to be having an anaphylactic 
reaction. To receive such preference, States would have to 
certify that their civil liability laws provide adequate civil 
liability protection to school personnel who administer 
epinephrine under such circumstances. School personnel would be 
required to receive training in the administration of 
epinephrine. Schools would be required to have a plan in place 
for having at least one trained employee on site during school 
hours and to maintain a supply of epinephrine in a secure 
location that is easily accessible.

         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 (new matter is 
printed in italic 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) * * *

           *       *       *       *       *       *       *

  (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) * * *

           *       *       *       *       *       *       *

                  (F) School personnel administration of 
                epinephrine.--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--
                          (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) 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) 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.
                  (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.

           *       *       *       *       *       *       *

          (3) Definitions.--For purposes of this subsection:
                  (A) * * *

           *       *       *       *       *       *       *

                  (E) The term ``trained personnel'' means, 
                with respect to an elementary or secondary 
                school, an individual--
                          (i) who has been designated by the 
                        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.

           *       *       *       *       *       *       *