42 U.S.C. § 280g — Children’s asthma treatment grants pro-

Page 558 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 280g 1 So in original. Two pars. (2) have been enacted. § 419(d), Nov. 13, 1998, 112 Stat. 3593; renumbered § 399H and amended Pub. L. 106–310, div. A, title V, § 502(4)(A), (B), Oct. 17, 2000, 114 Stat. 1115, required the Secretary of Health and Human Services to establish a com- prehensive Fetal Alcohol Syndrome and Fetal Alcohol Effect prevention, intervention and services delivery program and to establish the National Task Force on Fetal Alcohol Syndrome and Fetal Alcohol Effect. Section 280f–1, act July 1, 1944, ch. 373, title III, § 399I, formerly § 399H, as added Pub. L. 105–392, title IV, § 419(d), Nov. 13, 1998, 112 Stat. 3594; renumbered § 399I, Pub. L. 106–310, div. A, title V, § 502(4)(A), Oct. 17, 2000, 114 Stat. 1115, provided eligibility criteria for receiving a grant or entering into a cooperative agreement or contract under this part. Section 280f–2, act July 1, 1944, ch. 373, title III, § 399J, formerly § 399I, as added Pub. L. 105–392, title IV, § 419(d), Nov. 13, 1998, 112 Stat. 3595; renumbered § 399J and amended Pub. L. 106–310, div. A, title V, § 502(4)(A), (C), Oct. 17, 2000, 114 Stat. 1115, authorized appropria- tions to carry out this part. Section 280f–3, act July 1, 1944, ch. 373, title III, § 399K, formerly § 399J, as added Pub. L. 105–392, title IV, § 419(d), Nov. 13, 1998, 112 Stat. 3595; renumbered § 399K and amended Pub. L. 106–310, div. A, title V, § 502(4)(A), (D), Oct. 17, 2000, 114 Stat. 1115, provided for the expira- tion of this part 7 years after the date on which all members of the National Task Force had been ap- pointed. Statutory Notes and Related Subsidiaries CONGRESSIONAL FINDINGS AND PURPOSE Pub. L. 105–392, title IV, § 419(b), (c), Nov. 13, 1998, 112 Stat. 3591, 3592, as amended by Pub. L. 111–256, § 2(g), Oct. 5, 2010, 124 Stat. 2644, provided findings and purpose related to prevention of Fetal Alcohol Syndrome and Fetal Alcohol Effect. PART P—ADDITIONAL PROGRAMS § 280g. Children’s asthma treatment grants pro- gram (a) Authority to make grants (1) In general In addition to any other payments made under this chapter or title V of the Social Se- curity Act [42 U.S.C. 701 et seq.], 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 par- ents, 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 pre- viously had access to treatment or edu- cation in the management of asthma. (D) To provide other services, such as smoking cessation programs, home modi- fication, and other direct and support serv- ices that ameliorate conditions that exacer- bate or induce asthma. (2) 1 Certain projects In making grants under paragraph (1), the Secretary may make grants designed to de- velop 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 Insti- tute), including access to care and treat- ment for asthma in a community-based set- ting. (B) Projects to fully equip mobile health care clinics that provide preventive asthma care including diagnosis, physical examina- tions, pharmacological therapy, skin test- ing, peak flow meter testing, and other asth- ma-related health care services. (C) Projects to conduct validated asthma management education programs for pa- tients with asthma and their families, in- cluding patient education regarding asthma management, family education on asthma management, and the distribution of mate- rials, including displays and videos, to rein- force concepts presented by medical teams. (2) 1 Award of grants (A) Application (i) In general An eligible entity shall submit an appli- cation 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 sub- paragraph 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 sus- pected 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 mor- tality rates in the United States). Accept- able data sets to demonstrate a high preva- lence 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 [42 U.S.C. 1396 et seq., 1397aa et seq.], other public health statistics or surveys, or other data that the Secretary, in consultation with the Director of the Cen- ters for Disease Control and Prevention, deems appropriate. (3) Definition of eligible entity For purposes of this section, the term ‘‘eligi- ble entity’’ means a public or nonprofit pri- vate entity (including a State or political sub- division 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 Page 559 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 280g under this section how the entity will coordi- nate 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 [42 U.S.C. 701 et seq., 1396 et seq., 1397aa et seq.]; 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 [42 U.S.C. 620 et seq., 670 et seq.]; (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 1786 of this title; (D) local public and private elementary or secondary schools; or (E) public housing agencies, as defined in section 1437a of this title. (c) Evaluation An eligible entity that receives a grant under this section shall submit to the Secretary an evaluation of the operations and activities car- ried out under the grant that includes— (1) a description of the health status out- comes of children assisted under the grant; (2) an assessment of the utilization of asth- ma-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 pre- scribed by the Director of the Centers for Dis- ease 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-adminis- tration of medication to treat that student’s asthma or anaphylaxis, if— (i) a health care practitioner prescribed the medication for use by the student dur- ing school hours and instructed the stu- dent in the correct and responsible use of the medication; (ii) the student has demonstrated to the health care practitioner (or such practi- tioner’s designee) and the school nurse (if available) the skill level necessary to use the medication and any device that is nec- essary to administer such medication as prescribed; (iii) the health care practitioner formu- lates a written treatment plan for man- aging 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 for- mulated under clause (iii) and other docu- ments related to liability. (B) Scope An authorization granted under subpara- graph (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 subpara- graph (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 medi- cation, 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 anaphy- laxis 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 epi- nephrine or school comprehensive aller- gies 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 pref- erence to a State that provides to the Sec- retary the certification described in sub- paragraph (G) and that requires that each public elementary school and secondary school in the State satisfy the criteria de- scribed in clause (ii) or clause (iii). (ii) Criteria for school personnel adminis- tration of epinephrine For purposes of clause (i), the criteria described in this clause, with respect to each public elementary school and sec- ondary school in the State, are that each such school— (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 acces- Page 560 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 280g sible 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 op- erating hours of the school one or more individuals who are trained personnel of the school. (iii) Criteria for school comprehensive al- lergies and asthma management pro- gram For purposes of clause (i), the criteria described in this clause, with respect to each public elementary school and sec- ondary 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 oper- ating hours of the school a school nurse or one or more other individuals who are designated by the principal (or other ap- propriate administrative staff) of the school to direct and apply the program described in subclause (II) on a vol- untary basis outside their scope of em- ployment; and (II) has in place, under the direction of a school nurse or other individual des- ignated under subclause (I), a com- prehensive school-based allergies and asthma management program that in- cludes— (aa) a method to identify all students of such school with a diagnosis of aller- gies and asthma; (bb) an individual student allergies and asthma action plan for each stu- dent of such school with a diagnosis of allergies and asthma; (cc) allergies and asthma education for school staff who are directly re- sponsible for students who have been identified as having allergies or asth- ma, such as education regarding ba- sics, management, trigger manage- ment, 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, pri- mary asthma or allergy care providers of such students, and others as nec- essary. (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 pro- tection law to determine the application of such law with regard to elementary and sec- ondary school trained personnel who may administer epinephrine to a student reason- ably 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 indi- viduals 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 dimin- ishes 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 7801 of title 20. (B) The term ‘‘health care practitioner’’ means a person authorized under law to pre- scribe drugs subject to section 353(b) of title 21. (C) The term ‘‘medication’’ means a drug as that term is defined in section 321 of title 21 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 medica- tion, 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 ad- minister epinephrine on a voluntary basis outside their scope of employment; (ii) who has received training in the ad- ministration of epinephrine; and (iii) whose training in the administra- tion of epinephrine meets appropriate medical standards and has been docu- mented 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. (July 1, 1944, ch. 373, title III, § 399L, as added Pub. L. 106–310, div. A, title V, § 501, Oct. 17, 2000, 114 Stat. 1113; amended Pub. L. 108–377, § 3(a), Oct. 30, 2004, 118 Stat. 2203; Pub. L. 113–48, § 2, Nov. 13, 2013, 127 Stat. 575; Pub. L. 114–95, title IX, § 9215(kkk)(2), Dec. 10, 2015, 129 Stat. 2187; Pub. L. 116–292, § 2, Jan. 5, 2021, 134 Stat. 4896.) Editorial Notes REFERENCES IN TEXT The Social Security Act, referred to in subsecs. (a)(1), (2)(B) and (b)(1), (2)(A), is act Aug. 14, 1935, ch. 531, 49 Stat. 620. Parts B and E of title IV of the Act are classi- fied generally to parts B (§ 620 et seq.) and E (§ 670 et Page 561 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 280g–1 seq.), respectively, of subchapter IV of chapter 7 of this title. Titles V, XIX, and XXI of the Act are classified generally to subchapters V (§ 701 et seq.), XIX (§ 1396 et seq.), and XXI (§ 1397aa et seq.), respectively, of chapter 7 of this title. For complete classification of this Act to the Code, see section 1305 of this title and Tables. The Head Start Act, referred to in subsec. (b)(2)(B), is subchapter B (§§ 635–657) of chapter 8 of subtitle A of title VI of Pub. L. 97–35, Aug. 13, 1981, 95 Stat. 499, which is classified generally to subchapter II (§ 9831 et seq.) of chapter 105 of this title. For complete classi- fication of this Act to the Code, see Short Title note set out under section 9801 of this title and Tables. PRIOR PROVISIONS A prior section 399L of act July 1, 1944, was renum- bered section 399F and is classified to section 280e–4 of this title. AMENDMENTS 2021—Subsec. (d)(1)(F). Pub. L. 116–292, § 2(1)(B), in- serted ‘‘or school comprehensive allergies and asthma management program’’ after ‘‘epinephrine’’ in heading; designated introductory provisions as cl. (i), inserted heading, and substituted ‘‘in the State satisfy the cri- teria described in clause (ii) or clause (iii).’’ for ‘‘in the State—’’; inserted cl. (ii) heading and introductory pro- visions; redesignated former cls. (i) to (iii) as subcls. (I) to (III), respectively, of cl. (ii); added cl. (iii); and re- aligned margins. Subsec. (d)(3)(E). Pub. L. 116–292, § 2(2)(A), inserted ‘‘, such as the school nurse’’ after ‘‘individual’’ in in- troductory provisions. Subsec. (d)(3)(E)(i). Pub. L. 116–292, § 2(2)(B), inserted ‘‘school nurse or’’ before ‘‘principal’’. 2015—Subsec. (d)(3)(A). Pub. L. 114–95 made technical amendment to reference in original act which appears in text as reference to section 7801 of title 20. 2013—Subsec. (d)(1)(F), (G). Pub. L. 113–48, § 2(1), added subpars. (F) and (G). Subsec. (d)(3)(E). Pub. L. 113–48, § 2(2), added subpar. (E). 2004—Subsecs. (d), (e). Pub. L. 108–377 added subsec. (d) and redesignated former subsec. (d) as (e). Statutory Notes and Related Subsidiaries EFFECTIVE DATE OF 2015 AMENDMENT Amendment by Pub. L. 114–95 effective Dec. 10, 2015, except with respect to certain noncompetitive pro- grams and competitive programs, see section 5 of Pub. L. 114–95, set out as a note under section 6301 of Title 20, Education. EFFECTIVE DATE OF 2004 AMENDMENT Pub. L. 108–377, § 3(b), Oct. 30, 2004, 118 Stat. 2204, pro- vided that: ‘‘The amendments made by this section [amending this section] shall apply only with respect to grants made on or after the date that is 9 months after the date of the enactment of this Act [Oct. 30, 2004].’’ FINDINGS OF 2004 AMENDMENT Pub. L. 108–377, § 2, Oct. 30, 2004, 118 Stat. 2202, pro- vided that: ‘‘The Congress finds the following: ‘‘(1) Asthma is a chronic condition requiring life- time, ongoing medical intervention. ‘‘(2) In 1980, 6,700,000 Americans had asthma. ‘‘(3) In 2001, 20,300,000 Americans had asthma; 6,300,000 children under age 18 had asthma. ‘‘(4) The prevalence of asthma among African- American children was 40 percent greater than among Caucasian children, and more than 26 percent of all asthma deaths are in the African-American popu- lation. ‘‘(5) In 2000, there were 1,800,000 asthma-related vis- its to emergency departments (more than 728,000 of these involved children under 18 years of age). ‘‘(6) In 2000, there were 465,000 asthma-related hos- pitalizations (214,000 of these involved children under 18 years of age). ‘‘(7) In 2000, 4,487 people died from asthma, and of these 223 were children. ‘‘(8) According to the Centers for Disease Control and Prevention, asthma is a common cause of missed school days, accounting for approximately 14,000,000 missed school days annually. ‘‘(9) According to the New England Journal of Medi- cine, working parents of children with asthma lose an estimated $1,000,000,000 a year in productivity. ‘‘(10) At least 30 States have legislation protecting the rights of children to carry and self-administer asthma metered-dose inhalers, and at least 18 States expand this protection to epinephrine auto-injectors. ‘‘(11) Tragic refusals of schools to permit students to carry their inhalers and auto-injectable epineph- rine have occurred, some resulting in death and spawning litigation. ‘‘(12) School district medication policies must be developed with the safety of all students in mind. The immediate and correct use of asthma inhalers and auto-injectable epinephrine are necessary to avoid se- rious respiratory complications and improve health care outcomes. ‘‘(13) No school should interfere with the patient- physician relationship. ‘‘(14) Anaphylaxis, or anaphylactic shock, is a sys- temic allergic reaction that can kill within minutes. Anaphylaxis occurs in some asthma patients. Accord- ing to the American Academy of Allergy, Asthma, and Immunology, people who have experienced symp- toms of anaphylaxis previously are at risk for subse- quent reactions and should carry an epinephrine auto-injector with them at all times, if prescribed. ‘‘(15) An increasing number of students and school staff have life-threatening allergies. Exposure to the affecting allergen can trigger anaphylaxis. Anaphy- laxis requires prompt medical intervention with an injection of epinephrine.’’ § 280g–1. Early detection, diagnosis, and treat- ment regarding deaf and hard-of-hearing newborns, infants, and young children (a) Statewide newborn, infant, and young child hearing screening, evaluation and interven- tion programs and systems The Secretary, acting through the Adminis- trator of the Health Resources and Services Ad- ministration, shall make awards of grants or co- operative agreements to develop statewide new- born, infant, and young child hearing screening, evaluation, diagnosis, and intervention pro- grams and systems, and to assist in the recruit- ment, retention, education, and training of qualified personnel and health care providers (including, as appropriate, education and train- ing of family members), for the following pur- poses: (1) To develop and monitor the efficacy of statewide programs and systems for hearing screening of newborns, infants, and young children (referred to in this section as ‘‘chil- dren’’); prompt evaluation and diagnosis of children referred from screening programs; and appropriate educational, audiological, medical, and communication (or language ac- quisition) interventions (including family sup- port), for children identified as deaf or hard-of- hearing, consistent with the following: (A) Early intervention includes referral to, and delivery of, information and services by organizations such as schools and agencies (including community, consumer, and fam- ily-based agencies), in health care settings (including medical homes for children), and in programs mandated by part C of the Indi-