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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
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