II

103D CONGRESS

1ST SESSION S. 1318

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

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

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,
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1 SECTION 1. SHORT TITLE.

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

3 Preventive Health Act of 1993’’.

4 TITLE I—TUBERCULOSIS

5 SEC. 101. SHORT TITLE.

6 This title may be cited as the ‘‘Tuberculosis Preven7 tion and Control Amendments of 1993’’.

8 SEC. 102. FINDINGS.

9 Congress finds that—

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

11 in the United States have been infected with tuber12 culosis, nearly 26,000 new active cases are reported

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

14 deaths occur each year;

15 (2) the number of reported cases of tuberculosis

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

17 representing 51,000 more cases than those that

18 would have been expected since 1985;

19 (3) a recent national survey discovered that

20 14.4 percent of all active tuberculosis cases were re21 sistant to at least one drug;

22 (4) drug resistant tuberculosis strains can cost

23 more than $150,000 to treat, and even then, be24 tween 40 and 60 percent of the patients receiving

25 such treatment die;
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1 (5) in 1992, tuberculosis cases were reported to

2 the Centers for Disease Control and Prevention by

3 all 50 States, and cases resistant to one or more tu4 berculosis drugs were reported in at least 36 States,

5 the District of Columbia and Puerto Rico;

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

7 tuberculosis occurred in foreign born persons;

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

9 tuberculosis; and

10 (8) among infectious diseases tuberculosis is

11 still the number one killer in the world with an esti12 mated 8,000,000 new cases each year and 2,900,000

13 deaths.

14 SEC. 103. PROGRAMS OF CENTERS FOR DISEASE CONTROL

15 AND PREVENTION.

16 (a) PROVISION OF SERVICES FOR PREVENTION, CON17 TROL, AND ELIMINATION.—Section 317(j)(2) of the Pub18 lic Health Service Act (42 U.S.C. 247b(j)(2)) is amended

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

20 all that follows through ‘‘1995’’ and inserting the follow21 ing: ‘‘, $104,000,000 for fiscal year 1994, and such sums

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

23 through 1997’’.

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

25 the Public Health Service Act (42 U.S.C. 247b(j)) is
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1 amended by adding at the end thereof the following new

2 paragraph:

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

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

5 control and elimination of tuberculosis, such application

6 shall contain a State plan that demonstrates that amounts

7 received under the grant will be expended in a manner

8 that ensures that tuberculosis services will be provided to

9 those at the highest risk of contracting tuberculosis, or

10 in those areas with the highest rates of tuberculosis infec11 tion.

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

13 will work closely with and provide support to entities re14 ceiving funds under sections 329, 330, 340, 340A, or titles

15 V or XIX, and to correctional facilities, and nongovern16 mental organizations such as community-based organiza17 tions.

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

19 will be used for directly observed therapy or other effective

20 interventions with respect to populations with the highest

21 rates of active infection with tuberculosis.’’.

22 (c) RESEARCH, DEMONSTRATION PROJECTS, EDU23 CATION, AND TRAINING.—
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1 (1) IN GENERAL.—Section 317(k)(2) of the

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

3 amended—

4 (A) by redesignating subparagraphs (A)

5 through (D) as clauses (i) through (iv), respec6 tively;

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

8 designation; and

9 (C) by adding at the end thereof the fol10 lowing new subparagraphs:

11 ‘‘(B) In support of grants referred to in subpara12 graph (A), the Secretary may conduct or support applied

13 research and training regarding the surveillance, diag14 nostic methodologies, prevention, control, and treatment

15 of tuberculosis, including intramural projects and extra16 mural projects.

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

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

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

20 for each of the fiscal years 1995 through 1997. The au21 thorization of appropriations established in the preceding

22 sentence is in addition to the authorization of appropria23 tions established in subsection (j)(2) for carrying out this

24 paragraph.’’.
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1 (2) TECHNICAL AMENDMENT.—Section

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

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

4 sentence.

5 SEC. 104. RESEARCH THROUGH NATIONAL INSTITUTE OF

6 ALLERGY AND INFECTIOUS DISEASES.

7 (a) CERTAIN DUTIES.—

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

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

10 285f) is amended by inserting after section 446 the

11 following section:

12 ‘‘RESEARCH AND RESEARCH TRAINING REGARDING

13 TUBERCULOSIS

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

15 of the Institute shall conduct or support basic research

16 and research training regarding the cause, diagnosis, early

17 detection and treatment of tuberculosis.’’.

18 (2) CONFORMING AMENDMENT.—Section 446

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

20 is amended by inserting after ‘‘Diseases’’ the follow21 ing: ‘‘(hereafter in this subpart referred to as the

22 ‘Institute’)’’.

23 (b) AUTHORIZATION OF APPROPRIATIONS.—Section

24 408(a) of the Public Health Service Act (42 U.S.C.

25 284c(a)) is amended by adding at the end the following

26 new paragraph:
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1 ‘‘(3) For the purpose of carrying out section

2 447 (relating to research on tuberculosis through the

3 National Institute on Allergy and Infectious Dis4 eases), there are authorized to be appropriated

5 $46,000,000 for fiscal year 1994, and such sums as

6 may be necessary for each of the fiscal years 1995

7 through 1997. The authorization of appropriations

8 established in the preceding sentence may not be

9 construed as terminating the availability for such

10 purpose of any other authorization of appropria11 tions.’’.

12 SEC. 105. RESEARCH THROUGH THE FOOD AND DRUG AD13 MINISTRATION.

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

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

16 the following new section:

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

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

19 Drugs shall implement a tuberculosis drug and device re20 search program under which the Commissioner shall—

21 ‘‘(1) provide assistance to other Federal agen22 cies for the development of tuberculosis protocols;

23 ‘‘(2) review and evaluate medical devices de24 signed for the diagnosis and control of airborne tu25 berculosis; and
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1 ‘‘(3) conduct research concerning drugs or de2 vices to be used in diagnosing, controlling and pre3 venting tuberculosis.

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

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

6 $5,000,000 for each fiscal year.’’.

7 TITLE II—SEXUALLY

8 TRANSMITTED DISEASES

9 SEC. 201. SHORT TITLE.

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

11 Diseases Amendments of 1993’’.

12 SEC. 202. EXTENSION OF PROGRAM OF GRANTS REGARD13 ING PREVENTION AND CONTROL OF SEXU14 ALLY TRANSMITTED DISEASES.

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

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

17 amended in the first sentence—

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

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

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

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

22 authorized to be appropriated $132,000,000 for fis23 cal year 1994, and such sums as may be necessary

24 for each of the fiscal years 1995 through 1997.’’.
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1 (b) TECHNICAL CORRECTIONS.—Section 318 of the

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

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

4 and inserting ‘‘; and’’; and

5 (2) in subsection (d)(5)—

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

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

8 (B) in subparagraph (B), by striking ‘‘pur9 poses,’’ and inserting ‘‘purposes;’’.

10 SEC. 203. EXTENSION OF PROGRAM REGARDING PREVENT11 ABLE CASES OF INFERTILITY ARISING AS RE12 SULT OF SEXUALLY TRANSMITTED DISEASES.

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

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

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

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

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

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

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

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

21 is amended—

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

23 and inserting ‘‘through 1997’’; and

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

25 1995’’ and inserting ‘‘through 1998’’.
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1 SEC. 204. SEXUALLY TRANSMITTED DISEASE ACCELER2 ATED PREVENTION CAMPAIGNS.

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

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

5 247c-1) the following new section:

6 ‘‘SEC. 318B. SEXUALLY TRANSMITTED DISEASE ACCELER7 ATED PREVENTION CAMPAIGNS.

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

9 grants to States and political subdivisions of States for

10 the development, implementation, and evaluation of inno11 vative, interdisciplinary approaches to the prevention and

12 control of sexually transmitted diseases and their sequelae

13 by—

14 ‘‘(1) expanding access to sexually transmitted

15 disease services through collaborations with other

16 public health programs and with nongovernmental

17 partners;

18 ‘‘(2) implementing community-based behavioral

19 interventions to prevent disease transmission; and

20 ‘‘(3) establishing collaborations between health

21 departments and university-based experts to

22 strengthen sexually transmitted diseases prevention

23 programs.

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

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

26 a State, shall prepare and submit to the Secretary an ap-
11

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1 plication at such time, in such manner, and containing

2 such information as the Secretary may require.

3 ‘‘(c) PRIORITY.—In awarding grants under sub4 section (a), the Secretary shall give priority to applications

5 that seek to conduct activities with grant funds that focus

6 on the prevention of sexually transmitted diseases among

7 women and other populations that are disproportionately

8 affected by these diseases.’’.

9 TITLE III—INJURY CONTROL

10 AND VIOLENCE PREVENTION

11 SEC. 301. SHORT TITLE.

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

13 Violence Prevention Act of 1993’’.

14 SEC. 302. FINDINGS.

15 Congress finds that—

16 (1) violence or the threat of violence has ad17 verse effects on the health and safety of Americans

18 of all ages, races, ethnicities and economic condi19 tions;

20 (2) the majority of homicides and violent as21 saults are committed by people who have relation22 ships with their victims and are not committed by

23 strangers;

24 (3) violence is being committed in private as

25 well as public, in homes, schools, and neighborhoods;
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1 (4) interventions by law enforcement and crimi2 nal justice systems have limited ability to prevent

3 violence;

4 (5) family and interpersonal violence represent

5 serious threats to the health and well-being of mil6 lions of women in the United States;

7 (6) violence against women has serious health

8 consequences for its victims, including fatality, se9 vere trauma, repeated physical injuries, and chronic

10 stress-related disorder;

11 (7) violence against women has serious mental

12 health consequences for its victims, including sub13 stance abuse, severe psychological trauma, and sui14 cide;

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

16 correctly diagnosed by medical personnel as being

17 victims of domestic violence;

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

19 set of protocols for the identification and referral of

20 victims of family and interpersonal violence, or for

21 the training of health care professionals to perform

22 such functions;

23 (10) a national surveillance system for monitor24 ing the health effects of injury should be established
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1 to determine the nature and extent of family and

2 interpersonal violence in the United States; and

3 (11) the Surgeon General has identified domes4 tic violence as a public health problem to which all

5 health care providers must actively and vigorously

6 respond.

7 SEC. 303. FAMILY AND INTERPERSONAL VIOLENCE PRE8 VENTION.

9 Section 393 of the Public Health Service Act (42

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

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

12 VIOLENCE.

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

14 Secretary, acting through the Director of the Centers for

15 Disease Control and Prevention, may conduct research

16 and provide technical assistance to appropriate public and

17 nonprofit private entities and to academic institutions to

18 assist such entities in performing research in, and con19 ducting training and public health programs for, the pre20 vention of injuries and deaths associated with family and

21 interpersonal violence.

22 ‘‘(b) GRANTS.—The Secretary, acting through the

23 Director of the Centers for Disease Control and Preven24 tion, may award grants to States, political subdivisions of
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1 States, and any other public and nonprofit private entity

2 for—

3 ‘‘(1) the conduct of research into identifying ef4 fective strategies to prevent interpersonal violence

5 within the family and among acquaintances;

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

7 evaluation of demonstration projects for the preven8 tion of interpersonal violence within families and

9 among acquaintances;

10 ‘‘(3) the implementation of public information

11 and education programs for prevention of family and

12 interpersonal violence and to broaden public aware13 ness of the public health consequences of family and

14 interpersonal violence; and

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

16 clinical skills improvement programs for health care

17 professionals to—

18 ‘‘(A) routinely interview and identify indi19 viduals whose medical condition or statements

20 indicate that the individuals are victims of do21 mestic violence or sexual assault; and

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

23 provide services regarding such violence and as24 sault, including referrals for counseling, hous-
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1 ing, legal services, and services of community

2 organizations.

3 ‘‘(c) INJURY SURVEILLANCE PROGRAM.—The Sec4 retary, acting through the Director of the Centers for Dis5 ease Control and Prevention, shall support the establish6 ment of national systematic surveillance of injuries, in7 cluding those caused by family and interpersonal violence.

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

9 ‘interpersonal violence within families and acquaintances’

10 means any intentional violence, controlling, or coercive be11 havior or pattern of behavior by an individual who is cur12 rently or who was previously, in an intimate or acquaint13 ance relationship with the victim. Such behavior may

14 occur at any stage of the lifecycle and may encompass sin15 gle acts or a syndrome of actual or threatened physical

16 injury, sexual assault, rape, psychological abuse, or ne17 glect. Such term includes behavior which currently may

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

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

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

21 ‘‘(e) APPLICATION.—To be eligible to receive assist22 ance under subsection (a) or (b), an entity shall prepare

23 and submit to the Secretary an application at such time,

24 in such manner, and containing such information as the

25 Secretary may require.’’.
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1 SEC. 304. ADVISORY COMMITTEE; REPORTS.

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

3 (as amended by Public Law 103–43) is amended by insert4 ing after section 393 (42 U.S.C. 280b–2) the following

5 new section:

6 ‘‘SEC. 393A. GENERAL PROVISIONS.

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

8 through the Director of the Centers for Disease Control

9 and Prevention, shall establish an advisory committee to

10 advise the Secretary and such Director with respect to the

11 prevention and control of injuries.

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

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

14 through the Director of the Centers for Disease Control

15 and Prevention, shall submit to the Committee on Energy

16 and Commerce of the House of Representatives, and to

17 the Committee on Labor and Human Resources of the

18 Senate, a report describing the activities carried out under

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

20 shall include a description of such activities that were car21 ried out with respect to domestic violence and sexual as22 sault and with respect to rural areas.’’.

23 SEC. 305. TECHNICAL CORRECTIONS.

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

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

26 by Public Law 103–43) is amended—
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1 (1) in the heading for such part, by striking

2 ‘‘INJURY CONTROL’’ and inserting ‘‘PREVENTION

3 AND CONTROL OF INJURIES’’; and

4 (2) in section 392—

5 (A) in the heading for such section, by in6 serting ‘‘PREVENTION AND’’ before ‘‘CONTROL

7 ACTIVITIES’’;

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

9 control’’ after ‘‘prevention’’; and

10 (C) in subsection (b)(1), by striking ‘‘inju11 ries and injury control’’ and inserting ‘‘the pre12 vention and control of injuries’’.

13 (b) PROVISIONS RELATING TO PUBLIC LAW 102–

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

15 (42 U.S.C. 280b et seq.) (as amended by Public Law 103–

16 43 (106 Stat. 3482), is amended—

17 (1) in section 392(b)(2), by striking ‘‘to pro18 mote injury control’’ and all that follows and insert19 ing ‘‘to promote activities regarding the prevention

20 and control of injuries; and’’; and

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

22 following sentence: ‘‘In carrying out the preceding

23 sentence, the Secretary shall disseminate such infor24 mation to the public, including through elementary

25 and secondary schools.’’.
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1 SEC. 306. AUTHORIZATION OF APPROPRIATIONS.

2 Section 394 of the Public Health Service Act (42

3 U.S.C. 280b–3) is amended—

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

5 ‘‘391, 392, and 393’’; and

6 (2) by striking ‘‘$10,000,000’’ and all that fol7 lows through the period and inserting

8 ‘‘$60,000,000’’ for fiscal year 1994, and such sums

9 as may be necessary for each of the fiscal years

10 1995 through 1998.’’.

11 TITLE IV—BREAST AND CER12 VICAL CANCER AMENDMENTS

13 SEC. 401. SHORT TITLE.

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

15 Cancer Amendments of 1993’’.

16 SEC. 402. REVISIONS IN PROGRAM OF STATE GRANTS RE17 GARDING BREAST AND CERVICAL CANCER.

18 (a) LIMITED AUTHORITY REGARDING FOR-PROFIT

19 ENTITIES.—

20 (1) IN GENERAL.—Section 1501(b) of the Pub21 lic Health Service Act (42 U.S.C. 300k(b)) is

22 amended—

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

24 all that follows through ‘‘may expend’’ and in25 serting the following: ‘‘STATES.—
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1 ‘‘(1) IN GENERAL.—A State receiving a grant

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

3 and (3), expend’’; and

4 (B) by adding at the end the following

5 paragraphs:

6 ‘‘(2) LIMITED AUTHORITY REGARDING OTHER

7 ENTITIES.—In addition to the authority established

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

9 and contracts, the State may provide for screenings

10 under subsection (a)(1) through entering into con11 tracts with private entities.

12 ‘‘(3) PAYMENTS FOR SCREENINGS.—The

13 amount paid by a State to an entity under this sub14 section for a screening procedure under subsection

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

16 paid under part B of title XVIII of the Social Secu17 rity Act if payment were made under such part for

18 furnishing the procedure to a woman enrolled under

19 such part.’’.

20 (2) CONFORMING AMENDMENT.—Section

21 1505(3) of the Public Health Service Act (42 U.S.C.

22 300n–1(3)) is amended by inserting before the semi23 colon the following: ‘‘(and additionally, in the case of

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

25 any similar services or activities of private entities)’’.
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1 (b) SPECIAL CONSIDERATION FOR GRANTS.—Section

2 1501 of the Public Health Service Act (42 U.S.C. 300k)

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

4 subsection:

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

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

7 subsection, the Secretary shall give special consideration

8 to projects that have been peer reviewed and approved and

9 that involve areas that—

10 ‘‘(1) have high cervical or breast cancer mortal11 ity rates; or

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

13 cancer.’’.

14 (c) EXEMPTION FROM MATCHING REQUIREMENTS.—

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

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

17 ‘‘(1) TYPES OF CONTRIBUTIONS.—

18 ‘‘(A) GENERAL RULE.—Non-Federal con19 tributions required in subsection (a) may be in

20 cash or in kind, fairly evaluated, including

21 equipment or services (and excluding indirect or

22 overhead costs). Amounts provided by the Fed23 eral Government, or services assisted or sub24 sidized to any significant extent by the Federal

25 Government, may not be included in determin-
21

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1 ing the amount of such non-Federal contribu2 tions.

3 ‘‘(B) DONATED TREATMENT SERVICES.—

4 In meeting the non-Federal contribution re5 quirement of this section, the State involved—

6 ‘‘(i) may, with respect to a grant

7 awarded for a program under paragraph

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

9 of any donated outreach services associated

10 with the delivery of breast and cervical

11 cancer screenings conducted under the pro12 gram, and the value of any additional do13 nated breast or cervical cancer diagnostic

14 or treatment services provided subsequent

15 to the screening conducted under the pro16 gram; and

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

18 awarded for a program under paragraph

19 (3), (4), (5) or (6) of section 1501(a), in20 clude the value of any donated breast or

21 cervical cancer outreach, diagnosis, or

22 treatment services.’’.

23 (d) QUALITY ASSURANCE REGARDING SCREENING

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

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

3 (A) in subsection (a)—

4 (i) in paragraph (1), to read as fol5 lows:

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

7 time and thereafter throughout the period during

8 which amounts are received pursuant to the grant,

9 except for the period of the first year when a 50 per10 cent minimum shall apply, not less than 60 percent

11 of the grant is expended to provide each of the serv12 ices or activities described in paragraphs (1) and (2)

13 of section 1501(a), including making available

14 screening procedures for both breast and cervical

15 cancers;’’; and

16 (ii) in paragraph (4), to read as fol17 lows:

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

19 of the grant is expended to provide the services or

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

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

22 during which the maximum expended for these pur23 poses shall not exceed 50 percent of the grant.’’; and

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

25 and inserting the following:
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1 ‘‘(c) QUALITY ASSURANCE REGARDING SCREENING

2 PROCEDURES.—The Secretary may not make a grant

3 under section 1501 unless the State involved agrees that

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

5 the quality of screening procedures conducted pursuant to

6 such section.’’.

7 (2) TRANSITION RULE REGARDING

8 MAMMOGRAPHIES.—With respect to the screening

9 procedure for breast cancer known as a mammog10 raphy, the requirements in effect on the day before

11 the date of the enactment of this Act under section

12 1503(c) of the Public Health Service Act remain in

13 effect (for an individual or facility conducting such

14 procedures pursuant to a grant to a State under sec15 tion 1501 of such Act) until there is in effect for the

16 facility a certificate (or provisional certificate) issued

17 under section 354 of such Act.

18 (e) STATEWIDE PROVISION OF SERVICES.—Section

19 1504(c) of the Public Health Service Act (42 U.S.C.

20 300n(c)) is amended by adding at the end the following

21 paragraph:

22 ‘‘(3) GRANTS TO TRIBES AND TRIBAL ORGANI23 ZATIONS.—

24 ‘‘(A) The Secretary, acting through the Di25 rector of the Centers for Disease Control and
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1 Prevention, may make grants to tribes and trib2 al organizations (as such terms are used in

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

4 programs described in section 1501(a). This

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

6 jurisdiction of the tribe or organization) to the

7 same extent and in the same manner as such

8 title applies to a grant to a State under section

9 1501 (in relation to the jurisdiction of the

10 State).

11 ‘‘(B) If a tribe or tribal organization is re12 ceiving a grant under subparagraph (A) and the

13 State in which the tribe or organization is lo14 cated is receiving a grant under section 1501,

15 the requirement established in paragraph (1)

16 for the State regarding the tribe or organiza17 tion is deemed to have been waived under para18 graph (2).’’.

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

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

21 amended—

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

23 following sentence: ‘‘Such evaluations shall include

24 evaluations of the extent to which States carrying
25

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1 out such programs are in compliance with section

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

3 (2) in subsection (b), by inserting before the pe4 riod the following: ‘‘, including recommendations re5 garding compliance by the States with section

6 1501(a)(2) and with section 1504(c)’’.

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

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

9 amended—

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

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

12 ‘‘Control and Prevention,’’; and

13 (2) in section 1505—

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

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

16 and

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

18 before ‘‘be used’’.

19 SEC. 403. ESTABLISHMENT OF DEMONSTRATION PROGRAM

20 OF GRANTS FOR ADDITIONAL PREVENTIVE

21 HEALTH SERVICES FOR WOMEN.

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

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

24 (1) by redesignating section 1509 as section

25 1510; and
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1 (2) by inserting after section 1508 the following

2 section:

3 ‘‘SEC. 1509. SUPPLEMENTAL GRANTS FOR ADDITIONAL

4 PREVENTIVE HEALTH SERVICES.

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

6 States receiving grants under section 1501, the Secretary,

7 acting through the Director of the Centers for Disease

8 Control and Prevention, may make grants to not more

9 than 3 such States to carry out demonstration projects

10 for the purpose of—

11 ‘‘(1) providing preventive health services in ad12 dition to the services authorized in such section, in13 cluding screenings regarding blood pressure and cho14 lesterol, and including health education;

15 ‘‘(2) providing appropriate referrals for medical

16 treatment of women receiving services pursuant to

17 paragraph (1) and ensuring, to the extent prac18 ticable, the provision of appropriate follow-up serv19 ices; and

20 ‘‘(3) evaluating activities conducted under para21 graphs (1) and (2) through appropriate surveillance

22 or program-monitoring activities.

23 ‘‘(b) STATUS AS PARTICIPANT IN PROGRAM REGARD24 ING BREAST AND CERVICAL CANCER.—The Secretary

25 may not make a grant under subsection (a) unless the
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1 State involved agrees that services under the grant will

2 be provided only through entities that are screening

3 women for breast or cervical cancer pursuant to a grant

4 under section 1501.

5 ‘‘(c) APPLICABILITY OF PROVISIONS OF GENERAL

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

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

8 title applies to a grant under section 1501.

9 ‘‘(d) FUNDING.—

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

11 for the purpose of carrying out this section, there

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

13 fiscal year 1994, and such sums as may be nec14 essary for each of the fiscal years 1995 through

15 1998.

16 ‘‘(2) LIMITATION REGARDING FUNDING WITH

17 RESPECT TO BREAST AND CERVICAL CANCER.—The

18 authorization of appropriations established in para19 graph (1) is not effective for a fiscal year unless the

20 amount appropriated under section 1510(a) for the

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

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

23 the Public Health Service Act, as redesignated by sub24 section (a)(1) of this section, is amended in the heading
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1 for the section by striking ‘‘FUNDING.’’ and inserting

2 ‘‘FUNDING FOR GENERAL PROGRAM.’’.

3 SEC. 404. FUNDING FOR GENERAL PROGRAM.

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

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

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

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

8 ‘‘, $200,000,000 for fiscal year 1994, and such sums

9 as may be necessary for each of the fiscal years

10 1995 through 1997’’.

11 TITLE V—MISCELLANEOUS

12 PROVISIONS

13 SEC. 501. EVALUATIONS.

14 Section 2711 of the Public Health Service Act (42

15 U.S.C. 300aaa–10) is amended to read as follows:

16 ‘‘EVALUATION OF PROGRAMS

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

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

19 more than 1 percent, of any amounts appropriated for pro20 grams authorized under this Act for any fiscal year begin21 ning after September 20, 1993, shall be made available

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

23 the implementation and effectiveness of such programs.

24 ‘‘(b) REPORT ON EVALUATIONS.—

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

26 legislative deliberations concerning Federal health
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1 programs, the Secretary shall, not later than Janu2 ary 1 of each year, prepare and submit to the Com3 mittee on Labor and Human Resources of the Sen4 ate and the Committee on Energy and Commerce of

5 the House of Representatives a report that identifies

6 and synthesizes the findings of the evaluations con7 ducted under subsection (a) by program area. Such

8 report shall also include the plans of the Secretary

9 for the subsequent year’s evaluations, including pro10 grams and issue areas.

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

12 under paragraph (1) shall contain a description of

13 the findings of the Secretary with respect to evalua14 tions conducted under subsection (a) or other provi15 sions of law, during the 5-year period prior to the

16 year for which the report is being submitted. Such

17 description shall provide the Committees referred to

18 in paragraph (1) with information concerning pro19 gram changes that the Secretary intends to imple20 ment in response to such findings in order to im21 prove the health of the American people and their

22 receipt of needed and effective public health serv23 ices.’’.
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1 SEC. 502. FEDERAL BENEFITS FOR OVERSEAS ASSIGNEES.

2 Section 307 of the Public Health Service Act (42

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

4 following new subsection:

5 ‘‘(c) The Secretary may provide to personnel ap6 pointed or assigned by the Secretary to serve abroad, al7 lowances and benefits similar to those provided under

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

9 (22 U.S.C. 4081 et seq.). Leaves of absence for personnel

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

11 provided under subchapter I of chapter 63 of title 5,

12 United States Code to individuals serving in the Foreign

13 Service.’’.

14 SEC. 503. LOAN REPAYMENT PROGRAM.

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

16 (as amended by section 2008 of Public Law 103–43) is

17 amended by inserting after section 393 the following new

18 section:

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

20 ‘‘(a) IN GENERAL.—

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

22 the Secretary may carry out a program of entering

23 into contracts with appropriately qualified health

24 professionals under which such health professionals

25 agree to conduct prevention activities, as employees

26 of the Centers for Disease Control and Prevention
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1 and the Agency for Toxic Substances and Disease

2 Registry, in consideration of the Federal Govern3 ment agreeing to repay, for each year of such serv4 ice, not more than $20,000 of the principal and in5 terest of the educational loans of such health profes6 sionals.

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

8 enter into an agreement with a health professional

9 pursuant to paragraph (1) unless such profes10 sional—

11 ‘‘(A) has a substantial amount of edu12 cational loans relative to income; and

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

14 Centers for Disease Control and Prevention or

15 the Agency for Toxic Substances and Disease

16 Registry for purposes of paragraph (1) for a pe17 riod of not less than 3 years.

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

19 With respect to the National Health Service Corps Loan

20 Repayment Program established in subpart III of part D

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

22 except as inconsistent with subsection (a), apply to the

23 program established in this section in the same manner

24 and to the same extent as such provisions apply to the
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1 National Health Service Corps Loan Repayment Pro2 gram.’’.

3 SEC. 504. ESTABLISHMENT OF REQUIREMENT OF BIENNIAL

4 REPORT ON NUTRITION AND HEALTH.

5 Title XVII of the Public Health Service Act (42

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

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

8 the end the following section:

9 ‘‘BIENNIAL REPORT REGARDING NUTRITION AND HEALTH

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

11 shall require the Surgeon General of the Public Health

12 Service to prepare biennial reports on the relationship be13 tween nutrition and health. Such reports may, with re14 spect to such relationship, include any recommendations

15 of the Secretary and the Surgeon General regarding the

16 public health.

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

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

19 of every second year thereafter, a report under subsection

20 (a) is submitted to the Committee on Energy and Com21 merce of the House of Representatives and the Committee

22 on Labor and Human Resources of the Senate.

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

24 purpose of carrying out this section, there are authorized

25 to be appropriated such sums as may be necessary for

26 each of the fiscal years 1994 through 1997.’’.
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1 SEC. 505. ALIGNMENT OF CURRENT CENTERS FOR DISEASE

2 CONTROL AND PREVENTION REAUTHORIZA3 TION SCHEDULE.

4 (a) PROSTATE CANCER PREVENTION.—Section

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

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

7 ‘‘through 1997’’.

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

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

10 2003(1) of Public Law 103-43) is amended by striking

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

12 (c) HEALTH PROMOTION AND DISEASE PREVENTION

13 RESEARCH AND DEMONSTRATION CENTERS.—Section

14 1706(e) of such Act (42 U.S.C. 300u-5(e)) is amended

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

16 1997’’.

17 (d) SENSE OF CONGRESS.—It is the sense of Con18 gress that, beginning on the date of enactment of this Act

19 and continuing through fiscal year 1997, all Acts regard20 ing the authorization or reauthorization of Centers for

21 Disease Control and Prevention programs should be au22 thorized only through fiscal year 1997. Beginning in fiscal

23 year 1997, Congress should reauthorize the Centers for

24 Disease Control and Prevention and its programs in one

25 comprehensive Act. After fiscal year 1997, reauthorization
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1 of such Centers and its programs should occur on a regu2 lar cyclical basis.

Æ

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