Calendar No. 192

103D CONGRESS

1ST SESSION S. 1318

[Report No. 103–135]

A BILL

To amend the Public Health Service Act to extend

cer, and for other purposes.measures with respect to breast and cervical canprogram of grants relating to preventive healthcontrol programs, and to revise and extend theted diseases, to revise and extend certain injuryand control of tuberculosis and sexually transmitthe program of grants regarding the prevention

SEPTEMBER 7, 1993

Reported with an amendment
II

Calendar No. 192

103D CONGRESS

1ST SESSION S. 1318

[Report No. 103–135]

To amend the Public Health Service Act to extend the program of grants

regarding the prevention and control of tuberculosis and sexually transmitted diseases, to revise and extend certain injury control programs,

and to revise and extend the program of grants relating to preventive

health measures with respect to breast and cervical cancer, and for

other purposes.

IN THE SENATE OF THE UNITED STATES

JULY 29 (legislative day, JUNE 30), 1993

Mr. KENNEDY (for himself, Mrs. KASSEBAUM, Ms. MIKULSKI, Mr. HATCH,

Mr. WELLSTONE, Mr. RIEGLE, Mr. DODD, and Mr. WOFFORD) introduced the following bill; which was read twice and referred to the Committee on Labor and Human Resources

SEPTEMBER 7, 1993

Reported by Mr. KENNEDY, with an amendment

[Strike out all after the enacting clause and insert the part printed in italic]

A BILL

To amend the Public Health Service Act to extend the program of grants regarding the prevention and control

of tuberculosis and sexually transmitted diseases, to revise and extend certain injury control programs, and

to revise and extend the program of grants relating to
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preventive health measures with respect to breast and

cervical cancer, and for other purposes.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Early Detection and

5 Preventive Health Act of 1993’’.

6 TITLE I—TUBERCULOSIS

7 SEC. 101. SHORT TITLE.

8 This title may be cited as the ‘‘Tuberculosis Preven9 tion and Control Amendments of 1993’’.

10 SEC. 102. FINDINGS.

11 Congress finds that—

12 (1) between 10,000,000 and 15,000,000 people

13 in the United States have been infected with tuber14 culosis, nearly 26,000 new active cases are reported

15 each year, and over 1,700 tuberculosis-related

16 deaths occur each year;

17 (2) the number of reported cases of tuberculosis

18 has risen from 22,201 in 1985 to 26,673 in 1992,

19 representing 51,000 more cases than those that

20 would have been expected since 1985;

21 (3) a recent national survey discovered that

22 14.4 percent of all active tuberculosis cases were re23 sistant to at least one drug;
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1 (4) drug resistant tuberculosis strains can cost

2 more than $150,000 to treat, and even then, be3 tween 40 and 60 percent of the patients receiving

4 such treatment die;

5 (5) in 1992, tuberculosis cases were reported to

6 the Centers for Disease Control and Prevention by

7 all 50 States, and cases resistant to one or more tu8 berculosis drugs were reported in at least 36 States,

9 the District of Columbia and Puerto Rico;

10 (6) in 1992, 27 percent of the reported cases of

11 tuberculosis occurred in foreign born persons;

12 (7) one third of the world’s population harbors

13 tuberculosis; and

14 (8) among infectious diseases tuberculosis is

15 still the number one killer in the world with an esti16 mated 8,000,000 new cases each year and 2,900,000

17 deaths.

18 SEC. 103. PROGRAMS OF CENTERS FOR DISEASE CONTROL

19 AND PREVENTION.

20 (a) PROVISION OF SERVICES FOR PREVENTION, CON21 TROL, AND ELIMINATION.—Section 317(j)(2) of the Pub22 lic Health Service Act (42 U.S.C. 247b(j)(2)) is amended

23 in the first sentence by striking ‘‘and’’ after ‘‘1991,’’ and

24 all that follows through ‘‘1995’’ and inserting the follow25 ing: ‘‘, $104,000,000 for fiscal year 1994, and such sums
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1 as may be necessary for each of the fiscal years 1995

2 through 1997’’.

3 (b) STATE TUBERCULOSIS PLAN.—Section 317(j) of

4 the Public Health Service Act (42 U.S.C. 247b(j)) is

5 amended by adding at the end thereof the following new

6 paragraph:

7 ‘‘(3)(A) With respect to an application submitted by

8 a State for a grant under this section for the prevention,

9 control and elimination of tuberculosis, such application

10 shall contain a State plan that demonstrates that amounts

11 received under the grant will be expended in a manner

12 that ensures that tuberculosis services will be provided to

13 those at the highest risk of contracting tuberculosis, or

14 in those areas with the highest rates of tuberculosis infec15 tion.

16 ‘‘(B) Such plans shall demonstrate that the applicant

17 will work closely with and provide support to entities re18 ceiving funds under sections 329, 330, 340, 340A, or titles

19 V or XIX, and to correctional facilities, and nongovern20 mental organizations such as community-based organiza21 tions.

22 ‘‘(C) Such plans shall demonstrate that grant funds

23 will be used for directly observed therapy or other effective

24 interventions with respect to populations with the highest

25 rates of active infection with tuberculosis.’’.
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1 (c) RESEARCH, DEMONSTRATION PROJECTS, EDU2 CATION, AND TRAINING.—

3 (1) IN GENERAL.—Section 317(k)(2) of the

4 Public Health Service Act (42 U.S.C. 247b(k)(2)) is

5 amended—

6 (A) by redesignating subparagraphs (A)

7 through (D) as clauses (i) through (iv), respec8 tively;

9 (B) by inserting ‘‘(A)’’ after the paragraph

10 designation; and

11 (C) by adding at the end thereof the fol12 lowing new subparagraphs:

13 ‘‘(B) In support of grants referred to in subpara14 graph (A), the Secretary may conduct or support applied

15 research and training regarding the surveillance, diag16 nostic methodologies, prevention, control, and treatment

17 of tuberculosis, including intramural projects and extra18 mural projects.

19 ‘‘(C) For the purpose of carrying out subparagraph

20 (A), there are authorized to be appropriated $26,000,000

21 for fiscal year 1994, and such sums as may be necessary

22 for each of the fiscal years 1995 through 1997. The au23 thorization of appropriations established in the preceding

24 sentence is in addition to the authorization of appropria-
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1 tions established in subsection (j)(2) for carrying out this

2 paragraph.’’.

3 (2) TECHNICAL AMENDMENT.—Section

4 317(j)(2) of the Public Health Service Act (42

5 U.S.C. 247b(j)(2)) is amended by striking the last

6 sentence.

7 SEC. 104. RESEARCH THROUGH NATIONAL INSTITUTE OF

8 ALLERGY AND INFECTIOUS DISEASES.

9 (a) CERTAIN DUTIES.—

10 (1) IN GENERAL.—Subpart 6 of part C of title

11 IV of the Public Health Service Act (42 U.S.C.

12 285f) is amended by inserting after section 446 the

13 following section:

14 ‘‘RESEARCH AND RESEARCH TRAINING REGARDING

15 TUBERCULOSIS

16 ‘‘SEC. 447. In carrying out section 446, the Director

17 of the Institute shall conduct or support basic research

18 and research training regarding the cause, diagnosis, early

19 detection, prevention and treatment of tuberculosis.’’.

20 (2) CONFORMING AMENDMENT.—Section 446

21 of the Public Health Service Act (42 U.S.C. 285f)

22 is amended by inserting after ‘‘Diseases’’ the follow23 ing: ‘‘(hereafter in this subpart referred to as the

24 ‘Institute’)’’.

25 (b) AUTHORIZATION OF APPROPRIATIONS.—Section

26 408(a) of the Public Health Service Act (42 U.S.C.
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1 284c(a)) is amended by adding at the end the following

2 new paragraph:

3 ‘‘(3) For the purpose of carrying out section

4 447 (relating to research on tuberculosis through the

5 National Institute on Allergy and Infectious Dis6 eases), there are authorized to be appropriated

7 $46,000,000 for fiscal year 1994, and such sums as

8 may be necessary for each of the fiscal years 1995

9 through 1997. The authorization of appropriations

10 established in the preceding sentence may not be

11 construed as terminating the availability for such

12 purpose of any other authorization of appropria13 tions.’’.

14 SEC. 105. RESEARCH THROUGH THE FOOD AND DRUG AD15 MINISTRATION.

16 Chapter V of the Food, Drug and Cosmetic Act is

17 amended by inserting after section 512 (21 U.S.C. 360b)

18 the following new section:

19 ‘‘SEC. 512A. TUBERCULOSIS DRUG AND DEVICE RESEARCH.

20 ‘‘(a) AUTHORITY.—The Commissioner of Food and

21 Drugs shall implement a tuberculosis drug and device re22 search program under which the Commissioner shall—

23 ‘‘(1) provide assistance to other Federal agen24 cies for the development of tuberculosis protocols;
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1 ‘‘(2) review and evaluate medical devices de2 signed for the diagnosis and control of airborne tu3 berculosis; and

4 ‘‘(3) conduct research concerning drugs or de5 vices to be used in diagnosing, controlling and pre6 venting tuberculosis.

7 ‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There

8 are authorized to be appropriated to carry out this section,

9 $5,000,000 for each fiscal year.’’.

10 TITLE II—SEXUALLY

11 TRANSMITTED DISEASES

12 SEC. 201. SHORT TITLE.

13 This title may be cited as the ‘‘Sexually Transmitted

14 Diseases Amendments of 1993’’.

15 SEC. 202. EXTENSION OF PROGRAM OF GRANTS REGARD16 ING PREVENTION AND CONTROL OF SEXU17 ALLY TRANSMITTED DISEASES.

18 (a) EXTENSION OF PROGRAM.—Section 318(d)(1) of

19 the Public Health Service Act (42 U.S.C. 247c(d)(1)) is

20 amended in the first sentence—

21 (1) by striking ‘‘(b) and (c)’’ and inserting ‘‘(b)

22 and (c) of this section and section 318B’’; and

23 (2) by striking ‘‘there are authorized’’ and all

24 that follows and inserting the following: ‘‘there are

25 authorized to be appropriated $132,000,000 for fis-
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1 cal year 1994, and such sums as may be necessary

2 for each of the fiscal years 1995 through 1997.’’.

3 (b) TECHNICAL CORRECTIONS.—Section 318 of the

4 Public Health Service Act (42 U.S.C. 247c) is amended—

5 (1) in subsection (b)(3), by striking ‘‘, and’’

6 and inserting ‘‘; and’’; and

7 (2) in subsection (d)(5)—

8 (A) in subparagraph (A), by striking

9 ‘‘form, or’’ and inserting ‘‘form; or’’; and

10 (B) in subparagraph (B), by striking ‘‘pur11 poses,’’ and inserting ‘‘purposes;’’.

12 SEC. 203. EXTENSION OF PROGRAM REGARDING PREVENT13 ABLE CASES OF INFERTILITY ARISING AS RE14 SULT OF SEXUALLY TRANSMITTED DISEASES.

15 (a) TECHNICAL CORRECTION.—Section 318A of the

16 Public Health Service Act (42 U.S.C. 247c–1), as added

17 by section 304 of Public Law 102–531 (106 Stat. 3490),

18 is amended in subsection (o)(2) by striking ‘‘subsection

19 (s)’’ and inserting ‘‘subsection (q)’’.

20 (b) EXTENSION OF PROGRAM.—Section 318A of the

21 Public Health Service Act (42 U.S.C. 247c–1), as added

22 by section 304 of Public Law 102–531 (106 Stat. 3490),

23 is amended—

24 (1) in subsection (q), by striking ‘‘and 1995’’

25 and inserting ‘‘through 1997’’; and
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1 (2) in subsection (r)(2), by striking ‘‘through

2 1995’’ and inserting ‘‘through 1998’’.

3 SEC. 204. SEXUALLY TRANSMITTED DISEASE ACCELER4 ATED PREVENTION CAMPAIGNS.

5 Part B of title III of the Public Health Service Act

6 is amended by inserting after section 318A (42 U.S.C.

7 247c-1) the following new section:

8 ‘‘SEC. 318B. SEXUALLY TRANSMITTED DISEASE ACCELER9 ATED PREVENTION CAMPAIGNS.

10 ‘‘(a) GRANTS.—The Secretary is authorized to award

11 grants to States and political subdivisions of States for

12 the development, implementation, and evaluation of inno13 vative, interdisciplinary approaches to the prevention and

14 control of sexually transmitted diseases and their sequelae

15 by—

16 ‘‘(1) expanding access to sexually transmitted

17 disease services through collaborations with other

18 public health programs and with nongovernmental

19 partners;

20 ‘‘(2) implementing community-based behavioral

21 interventions to prevent disease transmission; and

22 ‘‘(3) establishing collaborations between health

23 departments and university-based experts to

24 strengthen sexually transmitted diseases prevention

25 programs.
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1 ‘‘(b) APPLICATION.—To be eligible to receive a grant

2 under subsection (a), a State or political subdivision of

3 a State, shall prepare and submit to the Secretary an ap4 plication at such time, in such manner, and containing

5 such information as the Secretary may require.

6 ‘‘(c) PRIORITY.—In awarding grants under sub7 section (a), the Secretary shall give priority to applications

8 that seek to conduct activities with grant funds that focus

9 on the prevention of sexually transmitted diseases among

10 women and other populations that are disproportionately

11 affected by these diseases.’’.

12 TITLE III—INJURY CONTROL

13 AND VIOLENCE PREVENTION

14 SEC. 301. SHORT TITLE.

15 This title may be cited as the ‘‘Injury Control and

16 Violence Prevention Act of 1993’’.

17 SEC. 302. FINDINGS.

18 Congress finds that—

19 (1) violence or the threat of violence has ad20 verse effects on the health and safety of Americans

21 of all ages, races, ethnicities and economic condi22 tions;

23 (2) the majority of homicides and violent as24 saults are committed by people who have relation-
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1 ships with their victims and are not committed by

2 strangers;

3 (3) violence is being committed in private as

4 well as public, in homes, schools, and neighborhoods;

5 (4) interventions by law enforcement and crimi6 nal justice systems have limited ability to prevent vi7 olence;

8 (5) family and interpersonal violence represent

9 serious threats to the health and well-being of mil10 lions of women in the United States;

11 (6) violence against women has serious health

12 consequences for its victims, including fatality, se13 vere trauma, repeated physical injuries, and chronic

14 stress-related disorder;

15 (7) violence against women has serious mental

16 health consequences for its victims, including sub17 stance abuse, severe psychological trauma, and sui18 cide;

19 (8) fewer than 5 percent of injured women are

20 correctly diagnosed by medical personnel as being

21 victims of domestic violence;

22 (9) hospitals and clinics do not have a uniform

23 set of protocols for the identification and referral of

24 victims of family and interpersonal violence, or for
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1 the training of health care professionals to perform

2 such functions;

3 (10) a national surveillance system for monitor4 ing the health effects of injury should be established

5 to determine the nature and extent of family and

6 interpersonal violence in the United States; and

7 (11) the Surgeon General has identified domes8 tic violence as a public health problem to which all

9 health care providers must actively and vigorously

10 respond.

11 SEC. 303. FAMILY AND INTERPERSONAL VIOLENCE PRE12 VENTION.

13 Section 393 of the Public Health Service Act (42

14 U.S.C. 280b–2) is amended to read as follows:

15 ‘‘SEC. 393. PREVENTION OF FAMILY AND INTERPERSONAL

16 VIOLENCE.

17 ‘‘(a) RESEARCH AND TECHNICAL ASSISTANCE.—The

18 Secretary, acting through the Director of the Centers for

19 Disease Control and Prevention, may conduct research

20 and provide technical assistance to appropriate public and

21 nonprofit private entities and to academic institutions to

22 assist such entities in performing research in, and con23 ducting training and public health programs for, the pre24 vention of injuries and deaths associated with family and

25 interpersonal violence.
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1 ‘‘(b) GRANTS.—The Secretary, acting through the

2 Director of the Centers for Disease Control and Preven3 tion, may award grants to States, political subdivisions of

4 States, and any other public and nonprofit private entity

5 for—

6 ‘‘(1) the conduct of research into identifying ef7 fective strategies to prevent interpersonal violence

8 within the family and among acquaintances;

9 ‘‘(2) the development, implementation, and

10 evaluation of demonstration projects for the preven11 tion of interpersonal violence within families and

12 among acquaintances;

13 ‘‘(3) the implementation of public information

14 and education programs for prevention of family and

15 interpersonal violence and to broaden public aware16 ness of the public health consequences of family and

17 interpersonal violence; and

18 ‘‘(4) the provision of education, training and

19 clinical skills improvement programs for health care

20 professionals to—

21 ‘‘(A) routinely interview and identify indi22 viduals whose medical condition or statements

23 indicate that the individuals are victims of do24 mestic violence or sexual assault; and
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1 ‘‘(B) refer the individuals to entities that

2 provide services regarding such violence and as3 sault, including referrals for counseling, hous4 ing, legal services, and services of community

5 organizations.

6 ‘‘(c) INJURY SURVEILLANCE PROGRAM.—The Sec7 retary, acting through the Director of the Centers for Dis8 ease Control and Prevention, shall support the establish9 ment of national systematic surveillance of injuries, in10 cluding those caused by family and interpersonal violence.

11 ‘‘(d) DEFINITION.—As used in this section, the term

12 ‘interpersonal violence within families and acquaintances’

13 means any intentional violence, controlling, or coercive be14 havior or pattern of behavior by an individual who is cur15 rently or who was previously, in an intimate or acquaint16 ance relationship with the victim. Such behavior may

17 occur at any stage of the lifecycle and may encompass sin18 gle acts or a syndrome of actual or threatened physical

19 injury, sexual assault, rape, psychological abuse, or ne20 glect. Such term includes behavior which currently may

21 be described as ‘child neglect’, ‘child abuse’, ‘spousal

22 abuse’, ‘domestic violence’, ‘woman battering’, ‘partner

23 abuse’, ‘elder abuse’, and ‘date rape’.

24 ‘‘(e) APPLICATION.—To be eligible to receive assist25 ance under subsection (a) or (b), an entity shall prepare
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1 and submit to the Secretary an application at such time,

2 in such manner, and containing such information as the

3 Secretary may require.’’.

4 SEC. 304. ADVISORY COMMITTEE; REPORTS.

5 Part J of title III of the Public Health Service Act

6 (as amended by Public Law 103-43) is amended by insert7 ing after section 393 (42 U.S.C. 280b-2) the following new

8 section:

9 ‘‘SEC. 393A. GENERAL PROVISIONS.

10 ‘‘(a) ADVISORY COMMITTEE.—The Secretary, acting

11 through the Director of the Centers for Disease Control

12 and Prevention, shall establish an advisory committee to

13 advise the Secretary and such Director with respect to the

14 prevention and control of injuries.

15 ‘‘(b) REPORT.—Not later than February 1 of 1994

16 and of every second year thereafter, the Secretary, acting

17 through the Director of the Centers for Disease Control

18 and Prevention, shall submit to the Committee on Energy

19 and Commerce of the House of Representatives, and to

20 the Committee on Labor and Human Resources of the

21 Senate, a report describing the activities carried out under

22 this part during the preceding 2 fiscal years. Such report

23 shall include a description of such activities that were car24 ried out with respect to domestic violence and sexual as25 sault and with respect to rural areas.’’.
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1 SEC. 305. TECHNICAL CORRECTIONS.

2 (a) TERMINOLOGY.—Part J of title III of the Public

3 Health Service Act (42 U.S.C. 280b et seq.) (as amended

4 by Public Law 103-43) is amended—

5 (1) in the heading for such part, by striking

6 ‘‘INJURY CONTROL’’ and inserting ‘‘PREVENTION

7 AND CONTROL OF INJURIES’’; and

8 (2) in section 392—

9 (A) in the heading for such section, by in10 serting ‘‘PREVENTION AND’’ before ‘‘CONTROL

11 ACTIVITIES’’;

12 (B) in subsection (a)(1), by inserting ‘‘and

13 control’’ after ‘‘prevention’’; and

14 (C) in subsection (b)(1), by striking ‘‘inju15 ries and injury control’’ and inserting ‘‘the pre16 vention and control of injuries’’.

17 (b) PROVISIONS RELATING TO PUBLIC LAW 102–

18 531.—Part J of title III of the Public Health Service Act

19 (42 U.S.C. 280b et seq.) (as amended by Public Law 103–

20 43 (106 Stat. 3482), is amended—

21 (1) in section 392(b)(2), by striking ‘‘to pro22 mote injury control’’ and all that follows and insert23 ing ‘‘to promote activities regarding the prevention

24 and control of injuries; and’’; and

25 (2) in section 391(b), by adding at the end the

26 following sentence: ‘‘In carrying out the preceding
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1 sentence, the Secretary shall disseminate such infor2 mation to the public, including through elementary

3 and secondary schools.’’.

4 SEC. 306. AUTHORIZATION OF APPROPRIATIONS.

5 Section 394 of the Public Health Service Act (42

6 U.S.C. 280b–3) is amended—

7 (1) by striking ‘‘391 and 392’’ and inserting

8 ‘‘391, 392, and 393’’; and

9 (2) by striking ‘‘$10,000,000’’ and all that fol10 lows through the period and inserting

11 ‘‘$60,000,000’’ for fiscal year 1994, and such sums

12 as may be necessary for each of the fiscal years

13 1995 through 1998.’’.

14 TITLE IV—BREAST AND CER15 VICAL CANCER AMENDMENTS

16 SEC. 401. SHORT TITLE.

17 This title may be cited as the ‘‘Breast and Cervical

18 Cancer Amendments of 1993’’.

19 SEC. 402. REVISIONS IN PROGRAM OF STATE GRANTS RE20 GARDING BREAST AND CERVICAL CANCER.

21 (a) LIMITED AUTHORITY REGARDING FOR-PROFIT

22 ENTITIES.—

23 (1) IN GENERAL.—Section 1501(b) of the Pub24 lic Health Service Act (42 U.S.C. 300k(b)) is

25 amended—
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1 (A) by striking ‘‘STATES.—A State’’ and

2 all that follows through ‘‘may expend’’ and in3 serting the following: ‘‘STATES.—

4 ‘‘(1) IN GENERAL.—A State receiving a grant

5 under subsection (a) may, subject to paragraphs (2)

6 and (3), expend’’; and

7 (B) by adding at the end the following

8 paragraphs:

9 ‘‘(2) LIMITED AUTHORITY REGARDING OTHER

10 ENTITIES.—In addition to the authority established

11 in paragraph (1) for a State with respect to grants

12 and contracts, the State may provide for screenings

13 under subsection (a)(1) through entering into con14 tracts with private entities.

15 ‘‘(3) PAYMENTS FOR SCREENINGS.—The

16 amount paid by a State to an entity under this sub17 section for a screening procedure under subsection

18 (a)(1) may not exceed the amount that would be

19 paid under part B of title XVIII of the Social Secu20 rity Act if payment were made under such part for

21 furnishing the procedure to a woman enrolled under

22 such part.’’.

23 (2) CONFORMING AMENDMENT.—Section

24 1505(3) of the Public Health Service Act (42 U.S.C.

25 300n-1(3)) is amended by inserting before the semi-
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1 colon the following: ‘‘(and additionally, in the case of

2 services and activities under section 1501(a)(1), with

3 any similar services or activities of private entities)’’.

4 (b) SPECIAL CONSIDERATION FOR GRANTS.—Section

5 1501 of the Public Health Service Act (42 U.S.C. 300k)

6 is amended by adding at the end thereof the following new

7 subsection:

8 ‘‘(c) SPECIAL CONSIDERATION.—In making grants

9 under subsection (a) after the date of enactment of this

10 subsection, the Secretary shall give special consideration

11 to projects that have been peer reviewed and approved and

12 that involve areas that—

13 ‘‘(1) have high cervical or breast cancer mortal14 ity rates; or

15 ‘‘(2) have a high incidence of cervical or breast

16 cancer.’’.

17 (c) EXEMPTION FROM MATCHING REQUIREMENTS.—

18 Section 1502(b)(1) of the Public Health Service Act (42

19 U.S.C. 300l(b)(1)) is amended to read as follows:

20 ‘‘(1) TYPES OF CONTRIBUTIONS.—

21 ‘‘(A) GENERAL RULE.—Non-Federal con22 tributions required in subsection (a) may be in

23 cash or in kind, fairly evaluated, including

24 equipment or services (and excluding indirect or

25 overhead costs). Amounts provided by the Fed-
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1 eral Government, or services assisted or sub2 sidized to any significant extent by the Federal

3 Government, may not be included in determin4 ing the amount of such non-Federal contribu5 tions.

6 ‘‘(B) DONATED TREATMENT SERVICES.—

7 In meeting the non-Federal contribution re8 quirement of this section, the State involved—

9 ‘‘(i) may, with respect to a grant

10 awarded for a program under paragraph

11 (1) or (2) of section 1501(a), use the value

12 of any donated outreach services associated

13 with the delivery of breast and cervical

14 cancer screenings conducted under the pro15 gram, and the value of any additional do16 nated breast or cervical cancer diagnostic

17 or treatment services provided subsequent

18 to the screening conducted under the pro19 gram; and

20 ‘‘(ii) may not, with respect to a grant

21 awarded for a program under paragraph

22 (3), (4), (5) or (6) of section 1501(a), in23 clude the value of any donated breast or

24 cervical cancer outreach, diagnosis, or

25 treatment services.’’.
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1 (d) QUALITY ASSURANCE REGARDING SCREENING

2 PROCEDURES.—

3 (1) IN GENERAL.—Section 1503 of the Public

4 Health Service Act (42 U.S.C. 300m) is amended—

5 (A) in subsection (a)—

6 (i) in paragraph (1), to read as fol7 lows:

8 ‘‘(1) to ensure that, after a limited period of

9 time and thereafter throughout the period during

10 which amounts are received pursuant to the grant,

11 except for the period of the first year when a 50 per12 cent minimum shall apply, not less than 60 percent

13 of the grant is expended to provide each of the serv14 ices or activities described in paragraphs (1) and (2)

15 of section 1501(a), including making available

16 screening procedures for both breast and cervical

17 cancers;’’; and

18 (ii) in paragraph (4), to read as fol19 lows:

20 ‘‘(4) to ensure that not more than 40 percent

21 of the grant is expended to provide the services or

22 activities described in paragraphs (3) through (6) of

23 section 1501(a), except in the case of the first year

24 during which the maximum expended for these pur25 poses shall not exceed 50 percent of the grant.’’; and
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1 (B) by striking subsections (c) through (e)

2 and inserting the following:

3 ‘‘(c) QUALITY ASSURANCE REGARDING SCREENING

4 PROCEDURES.—The Secretary may not make a grant

5 under section 1501 unless the State involved agrees that

6 the State will, in accordance with applicable law, assure

7 the quality of screening procedures conducted pursuant to

8 such section.’’.

9 (2) TRANSITION RULE REGARDING

10 MAMMOGRAPHIES.—With respect to the screening

11 procedure for breast cancer known as a mammog12 raphy, the requirements in effect on the day before

13 the date of the enactment of this Act under section

14 1503(c) of the Public Health Service Act remain in

15 effect (for an individual or facility conducting such

16 procedures pursuant to a grant to a State under sec17 tion 1501 of such Act) until there is in effect for the

18 facility a certificate (or provisional certificate) issued

19 under section 354 of such Act.

20 (e) STATEWIDE PROVISION OF SERVICES.—Section

21 1504(c) of the Public Health Service Act (42 U.S.C.

22 300n(c)) is amended by adding at the end the following

23 paragraph:

24 ‘‘(3) GRANTS TO TRIBES AND TRIBAL ORGANI25 ZATIONS.—
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1 ‘‘(A) The Secretary, acting through the Di2 rector of the Centers for Disease Control and

3 Prevention, may make grants to tribes and trib4 al organizations (as such terms are used in

5 paragraph (1)) for the purpose of carrying out

6 programs described in section 1501(a). This

7 title applies to such a grant (in relation to the

8 jurisdiction of the tribe or organization) to the

9 same extent and in the same manner as such

10 title applies to a grant to a State under section

11 1501 (in relation to the jurisdiction of the

12 State).

13 ‘‘(B) If a tribe or tribal organization is re14 ceiving a grant under subparagraph (A) and the

15 State in which the tribe or organization is lo16 cated is receiving a grant under section 1501,

17 the requirement established in paragraph (1)

18 for the State regarding the tribe or organiza19 tion is deemed to have been waived under para20 graph (2).’’.

21 (f) EVALUATIONS AND REPORTS.—Section 1508 of

22 the Public Health Service Act (42 U.S.C. 300n–4) is

23 amended—

24 (1) in subsection (a), by adding at the end the

25 following sentence: ‘‘Such evaluations shall include
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1 evaluations of the extent to which States carrying

2 out such programs are in compliance with section

3 1501(a)(2) and with section 1504(c).’’; and

4 (2) in subsection (b), by inserting before the pe5 riod the following: ‘‘, including recommendations re6 garding compliance by the States with section

7 1501(a)(2) and with section 1504(c)’’.

8 (g) TECHNICAL CORRECTIONS.—Title XV of the

9 Public Health Service Act (42 U.S.C. 300k et seq.) is

10 amended—

11 (1) in section 1501(a), in the matter preceding

12 paragraph (1), by striking ‘‘Control,’’ and inserting

13 ‘‘Control and Prevention,’’; and

14 (2) in section 1505—

15 (A) in paragraph (3), by striking

16 ‘‘nonprivate’’ and inserting ‘‘nonprofit private’’;

17 and

18 (B) in paragraph (4), by inserting ‘‘will’’

19 before ‘‘be used’’.

20 SEC. 403. ESTABLISHMENT OF DEMONSTRATION PROGRAM

21 OF GRANTS FOR ADDITIONAL PREVENTIVE

22 HEALTH SERVICES FOR WOMEN.

23 (a) IN GENERAL.—Title XV of the Public Health

24 Service Act (42 U.S.C. 300k et seq.) is amended—
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1 (1) by redesignating section 1509 as section

2 1510; and

3 (2) by inserting after section 1508 the following

4 section:

5 ‘‘SEC. 1509. SUPPLEMENTAL GRANTS FOR ADDITIONAL

6 PREVENTIVE HEALTH SERVICES.

7 ‘‘(a) DEMONSTRATION PROJECTS.—In the case of

8 States receiving grants under section 1501, the Secretary,

9 acting through the Director of the Centers for Disease

10 Control and Prevention, may make grants to not more

11 than 3 such States to carry out demonstration projects

12 for the purpose of—

13 ‘‘(1) providing preventive health services in ad14 dition to the services authorized in such section, in15 cluding screenings regarding blood pressure and cho16 lesterol, and including health education;

17 ‘‘(2) providing appropriate referrals for medical

18 treatment of women receiving services pursuant to

19 paragraph (1) and ensuring, to the extent prac20 ticable, the provision of appropriate follow-up serv21 ices; and

22 ‘‘(3) evaluating activities conducted under para23 graphs (1) and (2) through appropriate surveillance

24 or program-monitoring activities.
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1 ‘‘(b) STATUS AS PARTICIPANT IN PROGRAM REGARD2 ING BREAST AND CERVICAL CANCER.—The Secretary

3 may not make a grant under subsection (a) unless the

4 State involved agrees that services under the grant will

5 be provided only through entities that are screening

6 women for breast or cervical cancer pursuant to a grant

7 under section 1501.

8 ‘‘(c) APPLICABILITY OF PROVISIONS OF GENERAL

9 PROGRAM.—This title applies to a grant under subsection

10 (a) to the same extent and in the same manner as such

11 title applies to a grant under section 1501.

12 ‘‘(d) FUNDING.—

13 ‘‘(1) IN GENERAL.—Subject to paragraph (2),

14 for the purpose of carrying out this section, there

15 are authorized to be appropriated $3,000,000 for

16 fiscal year 1994, and such sums as may be nec17 essary for each of the fiscal years 1995 through

18 1998.

19 ‘‘(2) LIMITATION REGARDING FUNDING WITH

20 RESPECT TO BREAST AND CERVICAL CANCER.—The

21 authorization of appropriations established in para22 graph (1) is not effective for a fiscal year unless the

23 amount appropriated under section 1510(a) for the

24 fiscal year equals or exceeds $100,000,000.’’.
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1 (b) CONFORMING AMENDMENT.—Section 1510(a) of

2 the Public Health Service Act, as redesignated by sub3 section (a)(1) of this section, is amended in the heading

4 for the section by striking ‘‘FUNDING.’’ and inserting

5 ‘‘FUNDING FOR GENERAL PROGRAM.’’.

6 SEC. 404. FUNDING FOR GENERAL PROGRAM.

7 Section 1510(a) of the Public Health Service Act (as

8 amended by section 403(a)(2)) is amended—

9 (1) by striking ‘‘and’’ after ‘‘1991,’’; and

10 (2) by inserting before the period the following:

11 ‘‘, $200,000,000 for fiscal year 1994, and such sums

12 as may be necessary for each of the fiscal years

13 1995 through 1997’’.

14 TITLE V—MISCELLANEOUS

15 PROVISIONS

16 SEC. 501. EVALUATIONS.

17 Section 2711 of the Public Health Service Act (42

18 U.S.C. 300aaa-10) is amended to read as follows:

19 ‘‘EVALUATION OF PROGRAMS

20 ‘‘SEC. (a) IN GENERAL.—Such portion as the Sec21 retary shall determine, but not less than .2 percent nor

22 more than 1 percent, of any amounts appropriated for pro23 grams authorized under this Act for any fiscal year begin24 ning after September 20, 1993, shall be made available

25 for the evaluation (directly, or by grants of contracts) of

26 the implementation and effectiveness of such programs.
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1 ‘‘(b) REPORT ON EVALUATIONS.—

2 ‘‘(1) IN GENERAL.—To provide information for

3 legislative deliberations concerning Federal health

4 programs, the Secretary shall, not later than Janu5 ary 1 of each year, prepare and submit to the Com6 mittee on Labor and Human Resources of the Sen7 ate and the Committee on Energy and Commerce of

8 the House of Representatives a report that identifies

9 and synthesizes the findings of the evaluations con10 ducted under subsection (a) by program area. Such

11 report shall also include the plans of the Secretary

12 for the subsequent year’s evaluations, including pro13 grams and issue areas.

14 ‘‘(2) FIVE YEAR REVIEW.—A report submitted

15 under paragraph (1) shall contain a description of

16 the findings of the Secretary with respect to evalua17 tions conducted under subsection (a) or other provi18 sions of law, during the 5-year period prior to the

19 year for which the report is being submitted. Such

20 description shall provide the Committees referred to

21 in paragraph (1) with information concerning pro22 gram changes that the Secretary intends to imple23 ment in response to such findings in order to im24 prove the health of the American people and their
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1 receipt of needed and effective public health serv2 ices.’’.

3 SEC. 502. FEDERAL BENEFITS FOR OVERSEAS ASSIGNEES.

4 Section 307 of the Public Health Service Act (42

5 U.S.C. 242l) is amended by adding at the end thereof the

6 following new subsection:

7 ‘‘(c) The Secretary may provide to personnel ap8 pointed or assigned by the Secretary to serve abroad, al9 lowances and benefits similar to those provided under

10 chapter 9 of title I of the Foreign Service Act of 1990

11 (22 U.S.C. 4081 et seq.). Leaves of absence for personnel

12 under this subsection shall be on the same basis as that

13 provided under subchapter I of chapter 63 of title 5, Unit14 ed States Code to individuals serving in the Foreign Serv15 ice.’’.

16 SEC. 503. LOAN REPAYMENT PROGRAM.

17 Part J of title III of the Public Health Service Act

18 (as amended by section 2008 of Public Law 103-43) is

19 amended by inserting after section 393 the following new

20 section:

21 ‘‘SEC. 393A. LOAN REPAYMENT PROGRAM.

22 ‘‘(a) IN GENERAL.—

23 ‘‘(1) AUTHORITY.—Subject to paragraph (2),

24 the Secretary may carry out a program of entering

25 into contracts with appropriately qualified health
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1 professionals under which such health professionals

2 agree to conduct prevention activities, as employees

3 of the Centers for Disease Control and Prevention

4 and the Agency for Toxic Substances and Disease

5 Registry, in consideration of the Federal Govern6 ment agreeing to repay, for each year of such serv7 ice, not more than $20,000 of the principal and in8 terest of the educational loans of such health profes9 sionals.

10 ‘‘(2) LIMITATION.—The Secretary may not

11 enter into an agreement with a health professional

12 pursuant to paragraph (1) unless such profes13 sional—

14 ‘‘(A) has a substantial amount of edu15 cational loans relative to income; and

16 ‘‘(B) agrees to serve as an employee of the

17 Centers for Disease Control and Prevention or

18 the Agency for Toxic Substances and Disease

19 Registry for purposes of paragraph (1) for a pe20 riod of not less than 3 years.

21 ‘‘(b) APPLICABILITY OF CERTAIN PROVISIONS.—

22 With respect to the National Health Service Corps Loan

23 Repayment Program established in subpart III of part D

24 of title III of this Act, the provisions of such subpart shall,

25 except as inconsistent with subsection (a), apply to the
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1 program established in this section in the same manner

2 and to the same extent as such provisions apply to the

3 National Health Service Corps Loan Repayment Pro4 gram.’’.

5 SEC. 504. ESTABLISHMENT OF REQUIREMENT OF BIENNIAL

6 REPORT ON NUTRITION AND HEALTH.

7 Title XVII of the Public Health Service Act (42

8 U.S.C. 300u et seq.), as amended by section 302 of Public

9 Law 102-531 (106 Stat. 3483), is amended by adding at

10 the end the following section:

11 ‘‘BIENNIAL REPORT REGARDING NUTRITION AND HEALTH

12 ‘‘SEC. 1709. (a) BIENNIAL REPORT.—The Secretary

13 shall require the Surgeon General of the Public Health

14 Service to prepare biennial reports on the relationship be15 tween nutrition and health. Such reports may, with re16 spect to such relationship, include any recommendations

17 of the Secretary and the Surgeon General regarding the

18 public health.

19 ‘‘(b) SUBMISSION TO CONGRESS.—The Secretary

20 shall ensure that, not later than February 1 of 1995 and

21 of every second year thereafter, a report under subsection

22 (a) is submitted to the Committee on Energy and Com23 merce of the House of Representatives and the Committee

24 on Labor and Human Resources of the Senate.

25 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—For the

26 purpose of carrying out this section, there are authorized
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1 to be appropriated such sums as may be necessary for

2 each of the fiscal years 1994 through 1998.’’.

3 SEC. 505. ALIGNMENT OF CURRENT CENTERS FOR DISEASE

4 CONTROL AND PREVENTION REAUTHORIZA5 TION SCHEDULE.

6 (a) PROSTATE CANCER PREVENTION.—Section

7 317D((l)(1) of such Act (42 U.S.C. 247b-5(l)(1)) is

8 amended by striking ‘‘through 1996’’ and inserting

9 ‘‘through 1997’’.

10 (b) CANCER REGISTRIES.—Section 399L(a) of such

11 Act (42 U.S.C. 280e-4(a)) (as amended by section

12 2003(1) of Public Law 103-43) is amended by striking

13 ‘‘through 1996’’ and inserting ‘‘through 1997’’.

14 (c) HEALTH PROMOTION AND DISEASE PREVENTION

15 RESEARCH AND DEMONSTRATION CENTERS.—Section

16 1706(e) of such Act (42 U.S.C. 300u-5(e)) is amended

17 by striking ‘‘through 1996’’ and inserting ‘‘through

18 1997’’.

19 (d) SENSE OF CONGRESS.—It is the sense of Con20 gress that, beginning on the date of enactment of this Act

21 and continuing through fiscal year 1997, all Acts regard22 ing the authorization or reauthorization of Centers for

23 Disease Control and Prevention programs should be au24 thorized only through fiscal year 1997. Beginning in fiscal

25 year 1997, Congress should reauthorize the Centers for
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1 Disease Control and Prevention and its programs in one

2 comprehensive Act. After fiscal year 1997, reauthorization

3 of such Centers and its programs should occur on a regu4 lar cyclical basis.

5 SECTION 1. SHORT TITLE.

6 This Act may be cited as the ‘‘Early Detection and

7 Preventive Health Act of 1993’’.

8 TITLE I—TUBERCULOSIS

9 SEC. 101. SHORT TITLE.

10 This title may be cited as the ‘‘Tuberculosis Prevention

11 and Control Amendments of 1993’’.

12 SEC. 102. FINDINGS.

13 Congress finds that—

14 (1) between 10,000,000 and 15,000,000 people in

15 the United States have been infected with tuberculosis,

16 nearly 26,000 new active cases are reported each year,

17 and over 1,700 tuberculosis-related deaths occur each

18 year;

19 (2) the number of reported cases of tuberculosis

20 has risen from 22,201 in 1985 to 26,673 in 1992, rep21 resenting 51,000 more cases than those that would

22 have been expected since 1985;

23 (3) a recent national survey discovered that 14.4

24 percent of all active tuberculosis cases were resistant

25 to at least one drug;
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1 (4) drug resistant tuberculosis strains can cost

2 more than $150,000 to treat, and even then, between

3 40 and 60 percent of the patients receiving such treat4 ment die;

5 (5) in 1992, tuberculosis cases were reported to

6 the Centers for Disease Control and Prevention by all

7 50 States, and cases resistant to one or more tuber8 culosis drugs were reported in at least 36 States, the

9 District of Columbia and Puerto Rico;

10 (6) in 1992, 27 percent of the reported cases of

11 tuberculosis occurred in foreign born persons;

12 (7) one third of the world’s population harbors

13 tuberculosis; and

14 (8) among infectious diseases tuberculosis is still

15 the number one killer in the world with an estimated

16 8,000,000 new cases each year and 2,900,000 deaths.

17 SEC. 103. PROGRAMS OF CENTERS FOR DISEASE CONTROL

18 AND PREVENTION.

19 (a) PROVISION OF SERVICES FOR PREVENTION, CON20 TROL, AND ELIMINATION.—Section 317(j)(2) of the Public

21 Health Service Act (42 U.S.C. 247b(j)(2)) is amended—

22 (1) by inserting ‘‘(A)’’ after the paragraph des23 ignation;

24 (2) in the first sentence by striking ‘‘and’’ after

25 ‘‘1991,’’ and all that follows through ‘‘1995’’ and in-
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1 serting the following: ‘‘, $200,000,000 for fiscal year

2 1994, and such sums as may be necessary for each of

3 the fiscal years 1995 through 1997, of which not more

4 than $50,000,000 may be made available in each such

5 fiscal year for grants under subparagraph (B)’’; and

6 (3) by adding at the end thereof the following

7 new subparagraph:

8 ‘‘(B) With respect to amounts made available to carry

9 out this subparagraph, the Secretary, acting through the

10 Director of the Centers for Disease Control and Prevention,

11 may use such amounts to make emergency grants for the

12 prevention, control, and elimination of tuberculosis. The

13 Secretary may make such a grant only if the geographic

14 area in which activities under the grant are to be carried

15 out has, relative to other areas, a substantial incidence of

16 cases of tuberculosis or a substantial rate of increase in such

17 cases.’’.

18 (b) STATE TUBERCULOSIS PLAN.—Section 317(j) of

19 the Public Health Service Act (42 U.S.C. 247b(j)) is amend20 ed by adding at the end thereof the following new para21 graph:

22 ‘‘(3)(A) With respect to an application submitted by

23 a State for a grant under this section for the prevention,

24 control and elimination of tuberculosis, such application

25 shall contain a State plan that demonstrates that amounts
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1 received under the grant will be expended in a manner that

2 ensures that tuberculosis services will be provided to those

3 at the highest risk of contracting tuberculosis, or in those

4 areas with the highest rates of tuberculosis infection.

5 ‘‘(B) Such plans shall demonstrate that the applicant

6 will work closely with and provide support to entities re7 ceiving funds under sections 329, 330, 340, 340A, or titles

8 V or XIX, and to correctional facilities, and nongovern9 mental organizations such as community-based organiza10 tions.

11 ‘‘(C) Such plans shall demonstrate that grant funds

12 will be used for directly observed therapy or other effective

13 interventions with respect to populations with the highest

14 rates of active infection with tuberculosis.’’.

15 (c) RESEARCH, DEMONSTRATION PROJECTS, EDU16 CATION, AND TRAINING.—

17 (1) IN GENERAL.—Section 317(k)(2) of the Pub18 lic Health Service Act (42 U.S.C. 247b(k)(2)) is

19 amended—

20 (A) by redesignating subparagraphs (A)

21 through (D) as clauses (i) through (iv), respec22 tively;

23 (B) by inserting ‘‘(A)’’ after the paragraph

24 designation; and
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1 (C) by adding at the end thereof the follow2 ing new subparagraphs:

3 ‘‘(B) In support of grants referred to in subparagraph

4 (A), the Secretary may conduct or support applied research

5 and training regarding the surveillance, diagnostic meth6 odologies, prevention, control, and treatment of tuberculosis,

7 including intramural projects and extramural projects.

8 ‘‘(C) For the purpose of carrying out subparagraphs

9 (A) and (B), there are authorized to be appropriated

10 $26,000,000 for fiscal year 1994, and such sums as may

11 be necessary for each of the fiscal years 1995 through 1997.

12 The authorization of appropriations established in the pre13 ceding sentence is in addition to the authorization of appro14 priations established in subsection (j)(2) for carrying out

15 this paragraph.’’.

16 (2) TECHNICAL AMENDMENT.—Section 317(j)(2)

17 of the Public Health Service Act (42 U.S.C.

18 247b(j)(2)) is amended by striking the last sentence.

19 SEC. 104. RESEARCH THROUGH NATIONAL INSTITUTE OF

20 ALLERGY AND INFECTIOUS DISEASES.

21 (a) CERTAIN DUTIES.—

22 (1) IN GENERAL.—Subpart 6 of part C of title

23 IV of the Public Health Service Act (42 U.S.C. 285f)

24 is amended by inserting after section 446 the follow25 ing section:
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1 ‘‘RESEARCH AND RESEARCH TRAINING REGARDING

2 TUBERCULOSIS

3 ‘‘SEC. 447. In carrying out section 446, the Director

4 of the Institute shall conduct or support basic research and

5 research training regarding the cause, diagnosis, early de6 tection, prevention and treatment of tuberculosis.’’.

7 (2) CONFORMING AMENDMENT.—Section 446 of

8 the Public Health Service Act (42 U.S.C. 285f) is

9 amended by inserting after ‘‘Diseases’’ the following:

10 ‘‘(hereafter in this subpart referred to as the ‘Insti11 tute’)’’.

12 (b) AUTHORIZATION OF APPROPRIATIONS.—Section

13 408(a) of the Public Health Service Act (42 U.S.C. 284c(a))

14 is amended by adding at the end the following new para15 graph:

16 ‘‘(3) For the purpose of carrying out section 447

17 (relating to research on tuberculosis through the Na18 tional Institute on Allergy and Infectious Diseases),

19 there are authorized to be appropriated $46,000,000

20 for fiscal year 1994, and such sums as may be nec21 essary for each of the fiscal years 1995 through 1997.

22 The authorization of appropriations established in the

23 preceding sentence may not be construed as terminat24 ing the availability for such purpose of any other au25 thorization of appropriations.’’.
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1 SEC. 105. RESEARCH THROUGH THE FOOD AND DRUG AD2 MINISTRATION.

3 Chapter V of the Food, Drug and Cosmetic Act is

4 amended by inserting after section 512 (21 U.S.C. 360b)

5 the following new section:

6 ‘‘SEC. 512A. TUBERCULOSIS DRUG AND DEVICE RESEARCH.

7 ‘‘(a) AUTHORITY.—The Commissioner of Food and

8 Drugs shall implement a tuberculosis drug and device re9 search program under which the Commissioner shall—

10 ‘‘(1) provide assistance to other Federal agencies

11 for the development of tuberculosis protocols;

12 ‘‘(2) review and evaluate medical devices de13 signed for the diagnosis and control of airborne tuber14 culosis; and

15 ‘‘(3) conduct research concerning drugs or de16 vices to be used in diagnosing, controlling and pre17 venting tuberculosis.

18 ‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There

19 are authorized to be appropriated to carry out this section,

20 $5,000,000 for each of the fiscal years 1994 through 1997.’’.

21 SEC. 106. CONVERSION OR RENOVATION OF PUBLIC

22 HEALTH FACILITIES.

23 Section 1610 of the Public Health Service Act (42

24 U.S.C. 300r) is amended by adding at the end the following

25 subsection:
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1 ‘‘(c)(1) With respect to services for the prevention, con2 trol, and elimination of tuberculosis, the Secretary may

3 make grants to public and nonprofit private entities for—

4 ‘‘(A) conversion of existing facilities into out5 patient medical facilities or facilities for long-term

6 care to provide such services for such populations;

7 ‘‘(B) renovation of inpatient facilities; or

8 ‘‘(C) renovation of facilities to provide such serv9 ices with respect to incarceration.

10 ‘‘(2) The amount of any grant under paragraph (1)

11 may not exceed 50 percent of the cost of the project for which

12 the grant is made unless the project is located in an area

13 determined by the Secretary to be an urban or rural poverty

14 area, in which case the grant may cover up to 75 percent

15 of such costs.

16 ‘‘(3) There are authorized to be appropriated for

17 grants under paragraph (1), $25,000,000 for fiscal year

18 1994, and such sums as may be necessary for each of the

19 fiscal years 1995 through 1997.’’.

20 TITLE II—SEXUALLY

21 TRANSMITTED DISEASES

22 SEC. 201. SHORT TITLE.

23 This title may be cited as the ‘‘Sexually Transmitted

24 Diseases Amendments of 1993’’.
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1 SEC. 202. EXTENSION OF PROGRAM OF GRANTS REGARDING

2 PREVENTION AND CONTROL OF SEXUALLY

3 TRANSMITTED DISEASES.

4 (a) EXTENSION OF PROGRAM.—Section 318(d)(1) of

5 the Public Health Service Act (42 U.S.C. 247c(d)(1)) is

6 amended in the first sentence—

7 (1) by striking ‘‘(b) and (c)’’ and inserting ‘‘(b)

8 and (c) of this section and section 318B’’; and

9 (2) by striking ‘‘there are authorized’’ and all

10 that follows and inserting the following: ‘‘there are

11 authorized to be appropriated $132,000,000 for fiscal

12 year 1994, and such sums as may be necessary for

13 each of the fiscal years 1995 through 1997.’’.

14 (b) TECHNICAL CORRECTIONS.—Section 318 of the

15 Public Health Service Act (42 U.S.C. 247c) is amended—

16 (1) in subsection (b)(3), by striking ‘‘, and’’ and

17 inserting ‘‘; and’’; and

18 (2) in subsection (d)(5)—

19 (A) in subparagraph (A), by striking ‘‘form,

20 or’’ and inserting ‘‘form; or’’; and

21 (B) in subparagraph (B), by striking ‘‘pur22 poses,’’ and inserting ‘‘purposes;’’.
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1 SEC. 203. EXTENSION OF PROGRAM REGARDING PREVENT2 ABLE CASES OF INFERTILITY ARISING AS RE3 SULT OF SEXUALLY TRANSMITTED DISEASES.

4 (a) TECHNICAL CORRECTION.—Section 318A of the

5 Public Health Service Act (42 U.S.C. 247c–1), as added by

6 section 304 of Public Law 102–531 (106 Stat. 3490), is

7 amended in subsection (o)(2) by striking ‘‘subsection (s)’’

8 and inserting ‘‘subsection (q)’’.

9 (b) EXTENSION OF PROGRAM.—Section 318A of the

10 Public Health Service Act (42 U.S.C. 247c–1), as added by

11 section 304 of Public Law 102–531 (106 Stat. 3490), is

12 amended—

13 (1) in subsection (q), by striking ‘‘and 1995’’

14 and inserting ‘‘through 1997’’; and

15 (2) in subsection (r)(2), by striking ‘‘through

16 1995’’ and inserting ‘‘through 1997’’.

17 SEC. 204. SEXUALLY TRANSMITTED DISEASE ACCELERATED

18 PREVENTION CAMPAIGNS.

19 Part B of title III of the Public Health Service Act

20 is amended by inserting after section 318A (42 U.S.C.

21 247c–1) the following new section:

22 ‘‘SEC. 318B. SEXUALLY TRANSMITTED DISEASE ACCELER23 ATED PREVENTION CAMPAIGNS.

24 ‘‘(a) GRANTS.—The Secretary is authorized to award

25 grants to States and political subdivisions of States for the

26 development, implementation, and evaluation of innovative,
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1 interdisciplinary approaches to the prevention and control

2 of sexually transmitted diseases and their sequelae by—

3 ‘‘(1) expanding access to sexually transmitted

4 disease services through collaborations with other pub5 lic health programs and with nongovernmental

6 partners;

7 ‘‘(2) implementing community-based behavioral

8 interventions to prevent disease transmission; and

9 ‘‘(3) establishing collaborations between health

10 departments and university-based experts to strength11 en sexually transmitted diseases prevention programs.

12 ‘‘(b) APPLICATION.—To be eligible to receive a grant

13 under subsection (a), a State or political subdivision of a

14 State, shall prepare and submit to the Secretary an appli15 cation at such time, in such manner, and containing such

16 information as the Secretary may require.

17 ‘‘(c) PRIORITY.—In awarding grants under subsection

18 (a), the Secretary shall give priority to applications that

19 seek to conduct activities with grant funds that focus on

20 the prevention of sexually transmitted diseases among

21 women and other populations that are disproportionately

22 affected by these diseases.’’.
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1 TITLE III—INJURY CONTROL

2 AND VIOLENCE PREVENTION

3 SEC. 301. SHORT TITLE.

4 This title may be cited as the ‘‘Injury Control and Vio5 lence Prevention Act of 1993’’.

6 SEC. 302. FINDINGS.

7 Congress finds that—

8 (1) violence or the threat of violence has adverse

9 effects on the health and safety of Americans of all

10 ages, races, ethnicities and economic conditions;

11 (2) the majority of homicides and violent as12 saults are committed by people who have relationships

13 with their victims and are not committed by strang14 ers;

15 (3) violence is being committed in private as

16 well as in public, in homes, schools, and neighbor17 hoods;

18 (4) interventions by law enforcement and crimi19 nal justice systems have limited ability to prevent vi20 olence;

21 (5) family and interpersonal violence represent

22 serious threats to the health and well-being of millions

23 of women in the United States;

24 (6) violence against women has serious health

25 consequences for its victims, including fatality, severe
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1 trauma, repeated physical injuries, and chronic

2 stress-related disorder;

3 (7) violence against women has serious mental

4 health consequences for its victims, including sub5 stance abuse, severe psychological trauma, and sui6 cide;

7 (8) fewer than 5 percent of injured women are

8 correctly diagnosed by medical personnel as being vic9 tims of domestic violence;

10 (9) hospitals and clinics do not have a uniform

11 set of protocols for the identification and referral of

12 victims of family and interpersonal violence, or for

13 the training of health care professionals to perform

14 such functions;

15 (10) a national surveillance system for monitor16 ing the health effects of injury should be established

17 to determine the nature and extent of family and

18 interpersonal violence in the United States; and

19 (11) the Surgeon General has identified domestic

20 violence as a public health problem to which all

21 health care providers must actively and vigorously re22 spond.
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1 SEC. 303. FAMILY AND INTERPERSONAL VIOLENCE PREVEN2 TION.

3 Section 393 of the Public Health Service Act (42

4 U.S.C. 280b–2) is amended to read as follows:

5 ‘‘SEC. 393. PREVENTION OF FAMILY AND INTERPERSONAL

6 VIOLENCE.

7 ‘‘(a) RESEARCH AND TECHNICAL ASSISTANCE.—The

8 Secretary, acting through the Director of the Centers for

9 Disease Control and Prevention, may conduct research and

10 provide technical assistance to appropriate public and non11 profit private entities and to academic institutions to assist

12 such entities in performing research in, and conducting

13 training and public health programs for, the prevention of

14 injuries and deaths associated with family and inter15 personal violence.

16 ‘‘(b) GRANTS.—The Secretary, acting through the Di17 rector of the Centers for Disease Control and Prevention,

18 may award grants to States, political subdivisions of

19 States, and any other public and nonprofit private entity

20 for—

21 ‘‘(1) the conduct of research into identifying ef22 fective strategies to prevent interpersonal violence

23 within the family and among acquaintances;

24 ‘‘(2) the development, implementation, and eval25 uation of demonstration projects for the prevention of
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1 interpersonal violence within families and among ac2 quaintances;

3 ‘‘(3) the implementation of public information

4 and education programs for prevention of family and

5 interpersonal violence and to broaden public aware6 ness of the public health consequences of family and

7 interpersonal violence; and

8 ‘‘(4) the provision of education, training and

9 clinical skills improvement programs for health care

10 professionals to—

11 ‘‘(A) routinely interview and identify indi12 viduals whose medical condition or statements

13 indicate that the individuals are victims of do14 mestic violence or sexual assault; and

15 ‘‘(B) refer the individuals to entities that

16 provide services regarding such violence and as17 sault, including referrals for counseling, housing,

18 legal services, and services of community organi19 zations.

20 ‘‘(c) INJURY SURVEILLANCE PROGRAM.—The Sec21 retary, acting through the Director of the Centers for Dis22 ease Control and Prevention, shall support the establish23 ment of national systematic surveillance of injuries, includ24 ing those caused by family and interpersonal violence.
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1 ‘‘(d) DEFINITION.—As used in this section, the term

2 ‘interpersonal violence within families and acquaintances’

3 means any intentional violence, controlling, or coercive be4 havior or pattern of behavior by an individual who is cur5 rently or who was previously, in an intimate or acquaint6 ance relationship with the victim. Such behavior may occur

7 at any stage of the lifecycle and may encompass single acts

8 or a syndrome of actual or threatened physical injury, sex9 ual assault, rape, psychological abuse, or neglect. Such term

10 includes behavior which currently may be described as

11 ‘child neglect’, ‘child abuse’, ‘spousal abuse’, ‘domestic vio12 lence’, ‘woman battering’, ‘partner abuse’, ‘elder abuse’, and

13 ‘date rape’.

14 ‘‘(e) APPLICATION.—To be eligible to receive assistance

15 under subsection (a) or (b), an entity shall prepare and

16 submit to the Secretary an application at such time, in

17 such manner, and containing such information as the Sec18 retary may require.’’.

19 SEC. 304. ADVISORY COMMITTEE; REPORTS.

20 Part J of title III of the Public Health Service Act

21 (as amended by Public Law 103-43) is amended by insert22 ing after section 393 (42 U.S.C. 280b-2) the following new

23 section:
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1 ‘‘SEC. 393A. GENERAL PROVISIONS.

2 ‘‘(a) ADVISORY COMMITTEE.—The Secretary, acting

3 through the Director of the Centers for Disease Control and

4 Prevention, shall establish an advisory committee to advise

5 the Secretary and such Director with respect to the preven6 tion and control of injuries.

7 ‘‘(b) REPORT.—Not later than February 1 of 1996 and

8 of every second year thereafter, the Secretary, acting

9 through the Director of the Centers for Disease Control and

10 Prevention, shall submit to the Committee on Energy and

11 Commerce of the House of Representatives, and to the Com12 mittee on Labor and Human Resources of the Senate, a

13 report describing the activities carried out under this part

14 during the preceding 2 fiscal years. Such report shall in15 clude a description of such activities that were carried out

16 with respect to domestic violence and sexual assault and

17 with respect to rural areas.’’.

18 SEC. 305. TECHNICAL CORRECTIONS.

19 (a) TERMINOLOGY.—Part J of title III of the Public

20 Health Service Act (42 U.S.C. 280b et seq.) (as amended

21 by Public Law 103-43) is amended—

22 (1) in the heading for such part, by striking ‘‘IN23 JURY CONTROL’’ and inserting ‘‘PREVENTION AND

24 CONTROL OF INJURIES’’; and

25 (2) in section 392—
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1 (A) in the heading for such section, by in2 serting ‘‘PREVENTION AND’’ before ‘‘CONTROL AC3 TIVITIES’’;

4 (B) in subsection (a)(1), by inserting ‘‘and

5 control’’ after ‘‘prevention’’; and

6 (C) in subsection (b)(1), by striking ‘‘inju7 ries and injury control’’ and inserting ‘‘the pre8 vention and control of injuries’’.

9 (b) PROVISIONS RELATING TO PUBLIC LAW 102–

10 531.—Part J of title III of the Public Health Service Act

11 (42 U.S.C. 280b et seq.) (as amended by Public Law 103–

12 43 (106 Stat. 3482)), is amended—

13 (1) in section 392(b)(2), by striking ‘‘to promote

14 injury control’’ and all that follows and inserting ‘‘to

15 promote activities regarding the prevention and con16 trol of injuries; and’’; and

17 (2) in section 391(b), by adding at the end the

18 following sentence: ‘‘In carrying out the preceding

19 sentence, the Secretary shall disseminate such infor20 mation to the public, including through elementary

21 and secondary schools.’’.

22 SEC. 306. AUTHORIZATION OF APPROPRIATIONS.

23 Section 394 of the Public Health Service Act (42

24 U.S.C. 280b–3) is amended—
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1 (1) by striking ‘‘391 and 392’’ and inserting

2 ‘‘391, 392, and 393’’; and

3 (2) by striking ‘‘$10,000,000’’ and all that fol4 lows through the period and inserting ‘‘$60,000,000’’

5 for fiscal year 1994, and such sums as may be nec6 essary for each of the fiscal years 1995 through

7 1997.’’.

8 TITLE IV—BREAST AND CER9 VICAL CANCER AMENDMENTS

10 SEC. 401. SHORT TITLE.

11 This title may be cited as the ‘‘Breast and Cervical

12 Cancer Amendments of 1993’’.

13 SEC. 402. REVISIONS IN PROGRAM OF STATE GRANTS RE14 GARDING BREAST AND CERVICAL CANCER.

15 (a) LIMITED AUTHORITY REGARDING FOR-PROFIT

16 ENTITIES.—

17 (1) IN GENERAL.—Section 1501(b) of the Public

18 Health Service Act (42 U.S.C. 300k(b)) is amended—

19 (A) by striking ‘‘STATES.—A State’’ and all

20 that follows through ‘‘may expend’’ and inserting

21 the following: ‘‘STATES.—

22 ‘‘(1) IN GENERAL.—A State receiving a grant

23 under subsection (a) may, subject to paragraphs (2)

24 and (3), expend’’; and
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1 (B) by adding at the end the following

2 paragraphs:

3 ‘‘(2) LIMITED AUTHORITY REGARDING OTHER

4 ENTITIES.—In addition to the authority established

5 in paragraph (1) for a State with respect to grants

6 and contracts, the State may provide for screenings

7 under subsection (a)(1) through entering into con8 tracts with private entities.

9 ‘‘(3) PAYMENTS FOR SCREENINGS.—The amount

10 paid by a State to an entity under this subsection for

11 a screening procedure under subsection (a)(1) may

12 not exceed the amount that would be paid under part

13 B of title XVIII of the Social Security Act if payment

14 were made under such part for furnishing the proce15 dure to a woman enrolled under such part.’’.

16 (2) CONFORMING AMENDMENT.—Section 1505(3)

17 of the Public Health Service Act (42 U.S.C. 300n18 1(3)) is amended by inserting before the semicolon the

19 following: ‘‘(and additionally, in the case of services

20 and activities under section 1501(a)(1), with any

21 similar services or activities of private entities)’’.

22 (b) SPECIAL CONSIDERATION FOR GRANTS.—Section

23 1501 of the Public Health Service Act (42 U.S.C. 300k) is

24 amended by adding at the end thereof the following new

25 subsection:
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1 ‘‘(c) SPECIAL CONSIDERATION.—In making grants

2 under subsection (a) after the date of enactment of this sub3 section, the Secretary shall give special consideration to

4 projects that have been peer reviewed and approved and

5 that involve areas that—

6 ‘‘(1) have high cervical or breast cancer mortal7 ity rates; or

8 ‘‘(2) have a high incidence of cervical or breast

9 cancer.’’.

10 (c) EXEMPTION FROM MATCHING REQUIREMENTS.—

11 Section 1502(b)(1) of the Public Health Service Act (42

12 U.S.C. 300l(b)(1)) is amended to read as follows:

13 ‘‘(1) TYPES OF CONTRIBUTIONS.—

14 ‘‘(A) GENERAL RULE.—Non-Federal con15 tributions required in subsection (a) may be in

16 cash or in kind, fairly evaluated, including

17 equipment or services (and excluding indirect or

18 overhead costs). Amounts provided by the Fed19 eral Government, or services assisted or sub20 sidized to any significant extent by the Federal

21 Government, may not be included in determin22 ing the amount of such non-Federal contribu23 tions.
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1 ‘‘(B) DONATED TREATMENT SERVICES.—In

2 meeting the non-Federal contribution require3 ment of this section, the State involved—

4 ‘‘(i) may, with respect to a grant

5 awarded for a program under paragraph

6 (1) or (2) of section 1501(a), use the value

7 of any donated outreach services associated

8 with the delivery of breast and cervical can9 cer screenings conducted under the program,

10 and the value of any additional donated

11 breast or cervical cancer diagnostic or treat12 ment services provided subsequent to the

13 screening conducted under the program; and

14 ‘‘(ii) may not, with respect to a grant

15 awarded for a program under paragraph

16 (3), (4), (5) or (6) of section 1501(a), in17 clude the value of any donated breast or cer18 vical cancer outreach, diagnosis, or treat19 ment services.’’.

20 (d) REQUIREMENTS WITH RESPECT TO TYPE AND

21 QUALITY OF SERVICES.—

22 (1) IN GENERAL.—Section 1503 of the Public

23 Health Service Act (42 U.S.C. 300m) is amended—

24 (A) in subsection (a)—
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1 (i) in paragraph (1), to read as fol2 lows:

3 ‘‘(1) to ensure that, after a limited period of time

4 and thereafter throughout the period during which

5 amounts are received pursuant to the grant, except for

6 the period of the first year when a 50 percent mini7 mum shall apply, not less than 60 percent of the

8 grant is expended to provide each of the services or

9 activities described in paragraphs (1) and (2) of sec10 tion 1501(a), including making available screening

11 procedures for both breast and cervical cancers;’’; and

12 (ii) in paragraph (4), to read as fol13 lows:

14 ‘‘(4) to ensure that not more than 40 percent of

15 the grant is expended to provide the services or activi16 ties described in paragraphs (3) through (6) of section

17 1501(a), except in the case of the first year during

18 which the maximum expended for these purposes shall

19 not exceed 50 percent of the grant.’’; and

20 (B) by striking subsections (c) through (e)

21 and inserting the following:

22 ‘‘(c) QUALITY ASSURANCE REGARDING SCREENING

23 PROCEDURES.—The Secretary may not make a grant

24 under section 1501 unless the State involved agrees that the

25 State will, in accordance with applicable law, assure the
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1 quality of screening procedures conducted pursuant to such

2 section.’’.

3 (2) TRANSITION RULE REGARDING

4 MAMMOGRAPHIES.—With respect to the screening pro5 cedure for breast cancer known as a mammography,

6 the requirements in effect on the day before the date

7 of the enactment of this Act under section 1503(c) of

8 the Public Health Service Act remain in effect (for an

9 individual or facility conducting such procedures

10 pursuant to a grant to a State under section 1501 of

11 such Act) until there is in effect for the facility a cer12 tificate (or provisional certificate) issued under sec13 tion 354 of such Act.

14 (e) STATEWIDE PROVISION OF SERVICES.—Section

15 1504(c) of the Public Health Service Act (42 U.S.C.

16 300n(c)) is amended by adding at the end the following

17 paragraph:

18 ‘‘(3) GRANTS TO TRIBES AND TRIBAL ORGANIZA19 TIONS.—

20 ‘‘(A) The Secretary, acting through the Di21 rector of the Centers for Disease Control and

22 Prevention, may make grants to tribes and tribal

23 organizations (as such terms are used in para24 graph (1)) for the purpose of carrying out pro25 grams described in section 1501(a). This title ap-
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1 plies to such a grant (in relation to the jurisdic2 tion of the tribe or organization) to the same ex3 tent and in the same manner as such title ap4 plies to a grant to a State under section 1501

5 (in relation to the jurisdiction of the State).

6 ‘‘(B) If a tribe or tribal organization is re7 ceiving a grant under subparagraph (A) and the

8 State in which the tribe or organization is lo9 cated is receiving a grant under section 1501, the

10 requirement established in paragraph (1) for the

11 State regarding the tribe or organization is

12 deemed to have been waived under paragraph

13 (2).’’.

14 (f) EVALUATIONS AND REPORTS.—Section 1508 of the

15 Public Health Service Act (42 U.S.C. 300n–4) is amend16 ed—

17 (1) in subsection (a), by adding at the end the

18 following sentence: ‘‘Such evaluations shall include

19 evaluations of the extent to which States carrying out

20 such programs are in compliance with section

21 1501(a)(2) and with section 1504(c).’’; and

22 (2) in subsection (b), by inserting before the pe23 riod the following: ‘‘, including recommendations re24 garding compliance by the States with section

25 1501(a)(2) and with section 1504(c)’’.
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1 (g) TECHNICAL CORRECTIONS.—Title XV of the Public

2 Health Service Act (42 U.S.C. 300k et seq.) is amended—

3 (1) in section 1501(a), in the matter preceding

4 paragraph (1), by striking ‘‘Control,’’ and inserting

5 ‘‘Control and Prevention,’’; and

6 (2) in section 1505—

7 (A) in paragraph (3), by striking

8 ‘‘nonprivate’’ and inserting ‘‘nonprofit private’’;

9 and

10 (B) in paragraph (4), by inserting ‘‘will’’

11 before ‘‘be used’’.

12 SEC. 403. ESTABLISHMENT OF DEMONSTRATION PROGRAM

13 OF GRANTS FOR ADDITIONAL PREVENTIVE

14 HEALTH SERVICES FOR WOMEN.

15 (a) IN GENERAL.—Title XV of the Public Health Serv16 ice Act (42 U.S.C. 300k et seq.) is amended—

17 (1) by redesignating section 1509 as section

18 1510; and

19 (2) by inserting after section 1508 the following

20 section:

21 ‘‘SEC. 1509. SUPPLEMENTAL GRANTS FOR ADDITIONAL PRE22 VENTIVE HEALTH SERVICES.

23 ‘‘(a) DEMONSTRATION PROJECTS.—In the case of

24 States receiving grants under section 1501, the Secretary,

25 acting through the Director of the Centers for Disease Con-
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1 trol and Prevention, may make grants to not more than

2 3 such States to carry out demonstration projects for the

3 purpose of—

4 ‘‘(1) providing preventive health services in ad5 dition to the services authorized in such section, in6 cluding screenings regarding blood pressure and cho7 lesterol, and including health education;

8 ‘‘(2) providing appropriate referrals for medical

9 treatment of women receiving services pursuant to

10 paragraph (1) and ensuring, to the extent practicable,

11 the provision of appropriate follow-up services; and

12 ‘‘(3) evaluating activities conducted under para13 graphs (1) and (2) through appropriate surveillance

14 or program-monitoring activities.

15 ‘‘(b) STATUS AS PARTICIPANT IN PROGRAM REGARD16 ING BREAST AND CERVICAL CANCER.—The Secretary may

17 not make a grant under subsection (a) unless the State in18 volved agrees that services under the grant will be provided

19 only through entities that are screening women for breast

20 or cervical cancer pursuant to a grant under section 1501.

21 ‘‘(c) APPLICABILITY OF PROVISIONS OF GENERAL PRO22 GRAM.—This title applies to a grant under subsection (a)

23 to the same extent and in the same manner as such title

24 applies to a grant under section 1501.

25 ‘‘(d) FUNDING.—
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1 ‘‘(1) IN GENERAL.—Subject to paragraph (2), for

2 the purpose of carrying out this section, there are au3 thorized to be appropriated $3,000,000 for fiscal year

4 1994, and such sums as may be necessary for each of

5 the fiscal years 1995 through 1997.

6 ‘‘(2) LIMITATION REGARDING FUNDING WITH RE7 SPECT TO BREAST AND CERVICAL CANCER.—The au8 thorization of appropriations established in para9 graph (1) is not effective for a fiscal year unless the

10 amount appropriated under section 1510(a) for the

11 fiscal year equals or exceeds $100,000,000.’’.

12 (b) CONFORMING AMENDMENT.—Section 1510(a) of

13 the Public Health Service Act, as redesignated by subsection

14 (a)(1) of this section, is amended in the heading for the

15 section by striking ‘‘FUNDING.’’ and inserting ‘‘FUNDING

16 FOR GENERAL PROGRAM.’’.

17 SEC. 404. FUNDING FOR GENERAL PROGRAM.

18 Section 1510(a) of the Public Health Service Act (as

19 amended by section 403(a)(2)) is amended—

20 (1) by striking ‘‘and’’ after ‘‘1991,’’; and

21 (2) by inserting before the period the following:

22 ‘‘, $200,000,000 for fiscal year 1994, and such sums

23 as may be necessary for each of the fiscal years 1995

24 through 1997’’.
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1 TITLE V—MISCELLANEOUS

2 PROVISIONS

3 SEC. 501. EVALUATIONS.

4 Section 2711 of the Public Health Service Act (42

5 U.S.C. 300aaa-10) is amended to read as follows:

6 ‘‘EVALUATION OF PROGRAMS

7 ‘‘SEC. 2711. (a) IN GENERAL.—Such portion as the

8 Secretary shall determine, but not less than .2 percent nor

9 more than 1 percent, of any amounts appropriated for pro10 grams authorized under this Act for any fiscal year begin11 ning after September 20, 1993, shall be made available for

12 the evaluation (directly, or by grants of contracts) of the

13 implementation and effectiveness of such programs.

14 ‘‘(b) REPORT ON EVALUATIONS.—

15 ‘‘(1) IN GENERAL.—To provide information for

16 legislative deliberations concerning Federal health

17 programs, the Secretary shall, not later than January

18 1 of each year, prepare and submit to the Committee

19 on Labor and Human Resources of the Senate and

20 the Committee on Energy and Commerce of the House

21 of Representatives a report that identifies and synthe22 sizes the findings of the evaluations conducted under

23 subsection (a) by program area. Such report shall

24 also include the plans of the Secretary for the subse-
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1 quent year’s evaluations, including programs and

2 issue areas.

3 ‘‘(2) FIVE YEAR REVIEW.—A report submitted

4 under paragraph (1) shall contain a description of

5 the findings of the Secretary with respect to evalua6 tions conducted under subsection (a) or other provi7 sions of law, during the 5-year period prior to the

8 year for which the report is being submitted. Such de9 scription shall provide the Committees referred to in

10 paragraph (1) with information concerning program

11 changes that the Secretary intends to implement in

12 response to such findings in order to improve the

13 health of the American people and their receipt of

14 needed and effective public health services.’’.

15 SEC. 502. FEDERAL BENEFITS FOR OVERSEAS ASSIGNEES.

16 Section 307 of the Public Health Service Act (42

17 U.S.C. 242l) is amended by adding at the end thereof the

18 following new subsection:

19 ‘‘(c) The Secretary may provide to personnel ap20 pointed or assigned by the Secretary to serve abroad, allow21 ances and benefits similar to those provided under chapter

22 9 of title I of the Foreign Service Act of 1990 (22 U.S.C.

23 4081 et seq.). Leaves of absence for personnel under this

24 subsection shall be on the same basis as that provided under
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1 subchapter I of chapter 63 of title 5, United States Code

2 to individuals serving in the Foreign Service.’’.

3 SEC. 503. LOAN REPAYMENT PROGRAM.

4 Part J of title III of the Public Health Service Act

5 (as amended by section 2008 of Public Law 103-43) is

6 amended by inserting after section 393A (as added by sec7 tion 304) the following new section:

8 ‘‘SEC. 393B. LOAN REPAYMENT PROGRAM.

9 ‘‘(a) IN GENERAL.—

10 ‘‘(1) AUTHORITY.—Subject to paragraph (2), the

11 Secretary may carry out a program of entering into

12 contracts with appropriately qualified health profes13 sionals under which such health professionals agree to

14 conduct prevention activities, as employees of the Cen15 ters for Disease Control and Prevention and the Agen16 cy for Toxic Substances and Disease Registry, in con17 sideration of the Federal Government agreeing to

18 repay, for each year of such service, not more than

19 $20,000 of the principal and interest of the edu20 cational loans of such health professionals.

21 ‘‘(2) LIMITATION.—The Secretary may not enter

22 into an agreement with a health professional pursu23 ant to paragraph (1) unless such professional—

24 ‘‘(A) has a substantial amount of edu25 cational loans relative to income; and
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1 ‘‘(B) agrees to serve as an employee of the

2 Centers for Disease Control and Prevention or

3 the Agency for Toxic Substances and Disease

4 Registry for purposes of paragraph (1) for a pe5 riod of not less than 3 years.

6 ‘‘(b) APPLICABILITY OF CERTAIN PROVISIONS.—With

7 respect to the National Health Service Corps Loan Repay8 ment Program established in subpart III of part D of title

9 III of this Act, the provisions of such subpart shall, except

10 as inconsistent with subsection (a), apply to the program

11 established in this section in the same manner and to the

12 same extent as such provisions apply to the National Health

13 Service Corps Loan Repayment Program.

14 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—For the

15 purpose of carrying out this section, there are authorized

16 to be appropriated $500,000 for each of the fiscal years

17 1994 through 1997.’’.

18 SEC. 504. ESTABLISHMENT OF REQUIREMENT OF BIENNIAL

19 REPORT ON NUTRITION AND HEALTH.

20 Title XVII of the Public Health Service Act (42 U.S.C.

21 300u et seq.), as amended by section 302 of Public Law

22 102-531 (106 Stat. 3483), is amended by adding at the end

23 the following section:

24 ‘‘BIENNIAL REPORT REGARDING NUTRITION AND HEALTH

25 ‘‘SEC. 1709. (a) BIENNIAL REPORT.—The Secretary

26 shall require the Surgeon General of the Public Health Serv-
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1 ice to prepare biennial reports on the relationship between

2 nutrition and health. Such reports may, with respect to

3 such relationship, include any recommendations of the Sec4 retary and the Surgeon General regarding the public health.

5 ‘‘(b) SUBMISSION TO CONGRESS.—The Secretary shall

6 ensure that, not later than February 1 of 1995 and of every

7 second year thereafter, a report under subsection (a) is sub8 mitted to the Committee on Energy and Commerce of the

9 House of Representatives and the Committee on Labor and

10 Human Resources of the Senate.

11 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—For the

12 purpose of carrying out this section, there are authorized

13 to be appropriated such sums as may be necessary for each

14 of the fiscal years 1994 through 1997.’’.

15 SEC. 505. ALIGNMENT OF CURRENT CENTERS FOR DISEASE

16 CONTROL AND PREVENTION REAUTHORIZA17 TION SCHEDULE.

18 (a) PROSTATE CANCER PREVENTION.—Section

19 317D((l)(1) of such Act (42 U.S.C. 247b-5(l)(1)) is amended

20 by striking ‘‘through 1996’’ and inserting ‘‘through 1997’’.

21 (b) CANCER REGISTRIES.—Section 399L(a) of such

22 Act (42 U.S.C. 280e-4(a)) (as amended by section 2003(1)

23 of Public Law 103-43) is amended by striking ‘‘through

24 1996’’ and inserting ‘‘through 1997’’.
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1 (c) HEALTH PROMOTION AND DISEASE PREVENTION

2 RESEARCH AND DEMONSTRATION CENTERS.—Section

3 1706(e) of such Act (42 U.S.C. 300u-5(e)) is amended by

4 striking ‘‘through 1996’’ and inserting ‘‘through 1997’’.

5 (d) SENSE OF CONGRESS.—It is the sense of Congress

6 that, beginning on the date of enactment of this Act and

7 continuing through fiscal year 1997, all Acts regarding the

8 authorization or reauthorization of Centers for Disease Con9 trol and Prevention programs should be authorized only

10 through fiscal year 1997. Beginning in fiscal year 1997,

11 Congress should reauthorize the Centers for Disease Control

12 and Prevention and its programs in one comprehensive Act.

13 After fiscal year 1997, reauthorization of such Centers and

14 its programs should occur on a regular cyclical basis.

15 SEC. 506. BREAST AND CERVICAL CANCER INFORMATION.

16 Title XXVII of the Public Health Service Act (42

17 U.S.C. 300aaa et seq.) is amended by adding at the end

18 the following new section:

19 ‘‘SEC. 2715. BREAST AND CERVICAL CANCER INFORMATION.

20 ‘‘(a) IN GENERAL.—Each of the entities referred to in

21 subsection (b) shall make available, to such individuals as

22 the entities determine appropriate, information (in a cul23 turally competent manner) concerning breast and cervical

24 cancer, including if appropriate, information on the need

25 for breast self-examinations and the skills for such self-ex-
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1 aminations, and shall refer such clients as the entities deter2 mine appropriate for breast and cervical cancer screening,

3 treatment or other services.

4 ‘‘(b) ENTITIES.—The entities referred to in subsection

5 (a) are—

6 ‘‘(1) a migrant health center receiving assistance

7 under section 329;

8 ‘‘(2) a community health center receiving assist9 ance under section 330;

10 ‘‘(3) an entity receiving assistance under section

11 340;

12 ‘‘(4) an alcohol or drug treatment entity or men13 tal health entity receiving assistance under title V or

14 title XIX;

15 ‘‘(5) a family planning project described in sec16 tion 1001;

17 ‘‘(6) an entity receiving assistance under title

18 XXVI;

19 ‘‘(7) a clinic that treats sexually transmitted dis20 eases and is authorized under section 318;

21 ‘‘(8) an entity receiving funds to provide pri22 mary health services to residents of public housing

23 under section 340A;

24 ‘‘(9) a non-Federal entity authorized under the

25 Indian Self-Determination Act; and
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1 ‘‘(10) a tuberculosis clinic receiving assistance

2 under section 317(j)(2) or 317(k)(2).’’.

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