Breast and Cervical Cancer Amendments of 1993

Summary: Breast and Cervical Cancer Amendments of 1993 - Amends Public Health Service Act provisions authorizing grants for breast and cervical cancer preventive health measures to allow States to make contracts with private entities, provided the amount paid does not exceed the amount that would be paid under title XVIII (Medicare) of the Social Security Act.  Requires special consideration to be given to projects that have been peer reviewed and approved and that involve areas that have high cervical or breast cancer mortality rates or a high incidence of such cancers.  Revises breast and cervical cancer screening quality assurance requirements. Allows the grants to be made to tribes and tribal organizations.  Includes these changes in evaluation and reporting requirements. 
Authorizes demonstration project grants to up to three States receiving the cancer grants to provide: (1) additional preventive services, including health education and screening regarding blood pressure and cholesterol; (2) referrals and follow up for women receiving the cancer services; and (3) related evaluations.  Authorizes appropriations. 
Authorizes appropriations to carry out the breast and cervical cancer preventive health measures provisions.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Breast and Cervical Cancer 
Amendments of 1993''.

SEC. 2. REVISIONS IN PROGRAM OF STATE GRANTS REGARDING BREAST AND 
              CERVICAL CANCER.

    (a) Limited Authority Regarding For-Profit Entities.--
            (1) In general.--Section 1501(b) of the Public Health 
        Service Act (42 U.S.C. 300k(b)) is amended--
                    (A) by striking ``States.--A State'' and all that 
                follows through ``may expend'' and inserting the 
                following: ``States.--
            ``(1) In general.--A State receiving a grant under 
        subsection (a) may, subject to paragraphs (2) and (3), 
        expend''; and
                    (B) by adding at the end the following paragraphs:
            ``(2) Limited authority regarding other entities.--In 
        addition to the authority established in paragraph (1) for a 
        State with respect to grants and contracts, the State may 
        provide for screenings under subsection (a)(1) through entering 
        into contracts with private entities.
            ``(3) Payments for screenings.--The amount paid by a State 
        to an entity under this subsection for a screening procedure 
        under subsection (a)(1) may not exceed the amount that would be 
        paid under part B of title XVIII of the Social Security Act if 
        payment were made under such part for furnishing the procedure 
        to a woman enrolled under such part.''.
            (2) Conforming amendment.--Section 1505(3) of the Public 
        Health Service Act (42 U.S.C. 300n-1(3)) is amended by 
        inserting before the semicolon the following: ``(and 
        additionally, in the case of services and activities under 
        section 1501(a)(1), with any similar services or activities of 
        private entities)''.
    (b) Special Consideration for Grants.--Section 1501 of the Public 
Health Service Act (42 U.S.C. 300k) is amended by adding at the end 
thereof the following new subsection:
    ``(c) Special Consideration.--In making grants under subsection (a) 
after the date of enactment of this subsection, the Secretary shall 
give special consideration to projects that have been peer reviewed and 
approved and that involve areas that--
            ``(1) have high cervical or breast cancer mortality rates; 
        or
            ``(2) have a high incidence of cervical or breast 
        cancer.''.
    (c) Exemption From Matching Requirements.--Section 1502(b)(1) of 
the Public Health Service Act (42 U.S.C. 300l(b)(1)) is amended to read 
as follows:
            ``(1) Types of contributions.--
                    ``(A) General rule.--Non-Federal contributions 
                required in subsection (a) may be in cash or in kind, 
                fairly evaluated, including equipment or services (and 
                excluding indirect or overhead costs). Amounts provided 
                by the Federal Government, or services assisted or 
                subsidized to any significant extent by the Federal 
                Government, may not be included in determining the 
                amount of such non-Federal contributions.
                    ``(B) Donated treatment services.--In meeting the 
                non-Federal contribution requirement of this section, 
                the State involved--
                            ``(i) may, with respect to a grant awarded 
                        for a program under paragraph (1) or (2) of 
                        section 1501(a), use the value of any donated 
                        outreach services associated with the delivery 
                        of breast and cervical cancer screenings 
                        conducted under the program, and the value of 
                        any additional donated breast or cervical 
                        cancer diagnostic or treatment services 
                        provided subsequent to the screening conducted 
                        under the program; and
                            ``(ii) may not, with respect to a grant 
                        awarded for a program under paragraph (3), (4), 
                        (5) or (6) of section 1501(a), include the 
                        value of any donated breast or cervical cancer 
                        outreach, diagnosis, or treatment services.''.
    (d) Quality Assurance Regarding Screening Procedures.--
            (1) In general.--Section 1503 of the Public Health Service 
        Act (42 U.S.C. 300m) is amended--
                    (A) in subsection (a)--
                            (i) in paragraph (1), to read as follows:
            ``(1) to ensure that, after a limited period of time and 
        thereafter throughout the period during which amounts are 
        received pursuant to the grant, except for the period of the 
        first year when a 50 percent minimum shall apply, not less than 
        60 percent of the grant is expended to provide each of the 
        services or activities described in paragraphs (1) and (2) of 
        section 1501(a), including making available screening 
        procedures for both breast and cervical cancers;''; and
                            (ii) in paragraph (4), to read as follows:
            ``(4) to ensure that not more than 40 percent of the grant 
        is expended to provide the services or activities described in 
        paragraphs (3) through (6) of section 1501(a), except in the 
        case of the first year during which the maximum expended for 
        these purposes shall not exceed 50 percent of the grant.''; and
                    (B) by striking subsections (c) through (e) and 
                inserting the following:
    ``(c) Quality Assurance Regarding Screening Procedures.--The 
Secretary may not make a grant under section 1501 unless the State 
involved agrees that the State will, in accordance with applicable law, 
assure the quality of screening procedures conducted pursuant to such 
section.''.
            (2) Transition rule regarding mammographies.--With respect 
        to the screening procedure for breast cancer known as a 
        mammography, the requirements in effect on the day before the 
        date of the enactment of this Act under section 1503(c) of the 
        Public Health Service Act remain in effect (for an individual 
        or facility conducting such procedures pursuant to a grant to a 
        State under section 1501 of such Act) until there is in effect 
        for the facility a certificate (or provisional certificate) 
        issued under section 354 of such Act.
    (e) Statewide Provision of Services.--Section 1504(c) of the Public 
Health Service Act (42 U.S.C. 300n(c)) is amended by adding at the end 
the following paragraph:
            ``(3) Grants to tribes and tribal organizations.--
                    ``(A) The Secretary, acting through the Director of 
                the Centers for Disease Control and Prevention, may 
                make grants to tribes and tribal organizations (as such 
                terms are used in paragraph (1)) for the purpose of 
                carrying out programs described in section 1501(a). 
                This title applies to such a grant (in relation to the 
                jurisdiction of the tribe or organization) to the same 
                extent and in the same manner as such title applies to 
                a grant to a State under section 1501 (in relation to 
                the jurisdiction of the State).
                    ``(B) If a tribe or tribal organization is 
                receiving a grant under subparagraph (A) and the State 
                in which the tribe or organization is located is 
                receiving a grant under section 1501, the requirement 
                established in paragraph (1) for the State regarding 
                the tribe or organization is deemed to have been waived 
                under paragraph (2).''.
    (f) Evaluations and Reports.--Section 1508 of the Public Health 
Service Act (42 U.S.C. 300n-4) is amended--
            (1) in subsection (a), by adding at the end the following 
        sentence: ``Such evaluations shall include evaluations of the 
        extent to which States carrying out such programs are in 
        compliance with section 1501(a)(2) and with section 1504(c).''; 
        and
            (2) in subsection (b), by inserting before the period the 
        following: ``, including recommendations regarding compliance 
        by the States with section 1501(a)(2) and with section 
        1504(c)''.
    (g) Technical Corrections.--Title XV of the Public Health Service 
Act (42 U.S.C. 300k et seq.) is amended--
            (1) in section 1501(a), in the matter preceding paragraph 
        (1), by striking ``Control,'' and inserting ``Control and 
        Prevention,''; and
            (2) in section 1505--
                    (A) in paragraph (3), by striking ``nonprivate'' 
                and inserting ``nonprofit private''; and
                    (B) in paragraph (4), by inserting ``will'' before 
                ``be used''.

SEC. 3. ESTABLISHMENT OF DEMONSTRATION PROGRAM OF GRANTS FOR ADDITIONAL 
              PREVENTIVE HEALTH SERVICES FOR WOMEN.

    (a) In General.--Title XV of the Public Health Service Act (42 
U.S.C. 300k et seq.) is amended--
            (1) by redesignating section 1509 as section 1510; and
            (2) by inserting after section 1508 the following section:

``SEC. 1509. SUPPLEMENTAL GRANTS FOR ADDITIONAL PREVENTIVE HEALTH 
              SERVICES.

    ``(a) Demonstration Projects.--In the case of States receiving 
grants under section 1501, the Secretary, acting through the Director 
of the Centers for Disease Control and Prevention, may make grants to 
not more than 3 such States to carry out demonstration projects for the 
purpose of--
            ``(1) providing preventive health services in addition to 
        the services authorized in such section, including screenings 
        regarding blood pressure and cholesterol, and including health 
        education;
            ``(2) providing appropriate referrals for medical treatment 
        of women receiving services pursuant to paragraph (1) and 
        ensuring, to the extent practicable, the provision of 
        appropriate follow-up services; and
            ``(3) evaluating activities conducted under paragraphs (1) 
        and (2) through appropriate surveillance or program-monitoring 
        activities.
    ``(b) Status as Participant in Program Regarding Breast and 
Cervical Cancer.--The Secretary may not make a grant under subsection 
(a) unless the State involved agrees that services under the grant will 
be provided only through entities that are screening women for breast 
or cervical cancer pursuant to a grant under section 1501.
    ``(c) Applicability of Provisions of General Program.--This title 
applies to a grant under subsection (a) to the same extent and in the 
same manner as such title applies to a grant under section 1501.
    ``(d) Funding.--
            ``(1) In general.--Subject to paragraph (2), for the 
        purpose of carrying out this section, there are authorized to 
        be appropriated $3,000,000 for fiscal year 1994, and such sums 
        as may be necessary for each of the fiscal years 1995 through 
        1998.
            ``(2) Limitation regarding funding with respect to breast 
        and cervical cancer.--The authorization of appropriations 
        established in paragraph (1) is not effective for a fiscal year 
        unless the amount appropriated under section 1510(a) for the 
        fiscal year equals or exceeds $100,000,000.''.
    (b) Conforming Amendment.--Section 1510(a) of the Public Health 
Service Act, as redesignated by subsection (a)(1) of this section, is 
amended in the heading for the section by striking ``funding.'' and 
inserting ``funding for general program.''.

SEC. 4. FUNDING FOR GENERAL PROGRAM.

    Section 1510(a) of the Public Health Service Act (as redesignated 
by section 3(a)(2)) is amended--
            (1) by striking ``and'' after ``1991,''; and
            (2) by inserting before the period the following: ``, 
        $200,000,000 for fiscal year 1994, and such sums as may be 
        necessary for each of the fiscal years 1995 through 1998''.