II

103D CONGRESS

1ST SESSION S. 1310

To amend the Public Health Service Act 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

Ms. MIKULSKI (for herself, Mr. KENNEDY, Mrs. KASSEBAUM, Mr. DODD, and

Mr. RIEGLE) 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 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,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Breast and Cervical

5 Cancer Amendments of 1993’’.
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1 SEC. 2. REVISIONS IN PROGRAM OF STATE GRANTS RE2 GARDING BREAST AND CERVICAL CANCER.

3 (a) LIMITED AUTHORITY REGARDING FOR-PROFIT

4 ENTITIES.—

5 (1) IN GENERAL.—Section 1501(b) of the Pub6 lic Health Service Act (42 U.S.C. 300k(b)) is

7 amended—

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

9 all that follows through ‘‘may expend’’ and in10 serting the following: ‘‘STATES.—

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

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

13 and (3), expend’’; and

14 (B) by adding at the end the following

15 paragraphs:

16 ‘‘(2) LIMITED AUTHORITY REGARDING OTHER

17 ENTITIES.—In addition to the authority established

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

19 and contracts, the State may provide for screenings

20 under subsection (a)(1) through entering into con21 tracts with private entities.

22 ‘‘(3) PAYMENTS FOR SCREENINGS.—The

23 amount paid by a State to an entity under this sub24 section for a screening procedure under subsection

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

26 paid under part B of title XVIII of the Social Secu-
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1 rity Act if payment were made under such part for

2 furnishing the procedure to a woman enrolled under

3 such part.’’.

4 (2) CONFORMING AMENDMENT.—Section

5 1505(3) of the Public Health Service Act (42 U.S.C.

6 300n-1(3)) is amended by inserting before the semi7 colon the following: ‘‘(and additionally, in the case of

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

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

10 (b) SPECIAL CONSIDERATION FOR GRANTS.—Section

11 1501 of the Public Health Service Act (42 U.S.C. 300k)

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

13 subsection:

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

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

16 subsection, the Secretary shall give special consideration

17 to projects that have been peer reviewed and approved and

18 that involve areas that—

19 ‘‘(1) have high cervical or breast cancer mortal20 ity rates; or

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

22 cancer.’’.

23 (c) EXEMPTION FROM MATCHING REQUIRE24 MENTS.—Section 1502(b)(1) of the Public Health Service

25 Act (42 U.S.C. 300l(b)(1)) is amended to read as follows:
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1 ‘‘(1) TYPES OF CONTRIBUTIONS.—

2 ‘‘(A) GENERAL RULE.—Non-Federal con3 tributions required in subsection (a) may be in

4 cash or in kind, fairly evaluated, including

5 equipment or services (and excluding indirect or

6 overhead costs). Amounts provided by the Fed7 eral Government, or services assisted or sub8 sidized to any significant extent by the Federal

9 Government, may not be included in determin10 ing the amount of such non-Federal contribu11 tions.

12 ‘‘(B) DONATED TREATMENT SERVICES.—

13 In meeting the non-Federal contribution re14 quirement of this section, the State involved—

15 ‘‘(i) may, with respect to a grant

16 awarded for a program under paragraph

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

18 of any donated outreach services associated

19 with the delivery of breast and cervical

20 cancer screenings conducted under the pro21 gram, and the value of any additional do22 nated breast or cervical cancer diagnostic

23 or treatment services provided subsequent

24 to the screening conducted under the pro25 gram; and
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1 ‘‘(ii) may not, with respect to a grant

2 awarded for a program under paragraph

3 (3), (4), (5) or (6) of section 1501(a), in4 clude the value of any donated breast or

5 cervical cancer outreach, diagnosis, or

6 treatment services.’’.

7 (d) QUALITY ASSURANCE REGARDING SCREENING

8 PROCEDURES.—

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

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

11 (A) in subsection (a)—

12 (i) in paragraph (1), to read as fol13 lows:

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

15 time and thereafter throughout the period during

16 which amounts are received pursuant to the grant,

17 except for the period of the first year when a 50 per18 cent minimum shall apply, not less than 60 percent

19 of the grant is expended to provide each of the serv20 ices or activities described in paragraphs (1) and (2)

21 of section 1501(a), including making available

22 screening procedures for both breast and cervical

23 cancers;’’; and

24 (ii) in paragraph (4), to read as fol25 lows:
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1 ‘‘(4) to ensure that not more than 40 percent

2 of the grant is expended to provide the services or

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

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

5 during which the maximum expended for these pur6 poses shall not exceed 50 percent of the grant.’’; and

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

8 and inserting the following:

9 ‘‘(c) QUALITY ASSURANCE REGARDING SCREENING

10 PROCEDURES.—The Secretary may not make a grant

11 under section 1501 unless the State involved agrees that

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

13 the quality of screening procedures conducted pursuant to

14 such section.’’.

15 (2) TRANSITION RULE REGARDING

16 MAMMOGRAPHIES.—With respect to the screening

17 procedure for breast cancer known as a mammog18 raphy, the requirements in effect on the day before

19 the date of the enactment of this Act under section

20 1503(c) of the Public Health Service Act remain in

21 effect (for an individual or facility conducting such

22 procedures pursuant to a grant to a State under sec23 tion 1501 of such Act) until there is in effect for the

24 facility a certificate (or provisional certificate) issued

25 under section 354 of such Act.
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1 (e) STATEWIDE PROVISION OF SERVICES.—Section

2 1504(c) of the Public Health Service Act (42 U.S.C.

3 300n(c)) is amended by adding at the end the following

4 paragraph:

5 ‘‘(3) GRANTS TO TRIBES AND TRIBAL ORGANI6 ZATIONS.—

7 ‘‘(A) The Secretary, acting through the Di8 rector of the Centers for Disease Control and

9 Prevention, may make grants to tribes and trib10 al organizations (as such terms are used in

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

12 programs described in section 1501(a). This

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

14 jurisdiction of the tribe or organization) to the

15 same extent and in the same manner as such

16 title applies to a grant to a State under section

17 1501 (in relation to the jurisdiction of the

18 State).

19 ‘‘(B) If a tribe or tribal organization is re20 ceiving a grant under subparagraph (A) and the

21 State in which the tribe or organization is lo22 cated is receiving a grant under section 1501,

23 the requirement established in paragraph (1)

24 for the State regarding the tribe or organiza-
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1 tion is deemed to have been waived under para2 graph (2).’’.

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

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

5 amended—

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

7 following sentence: ‘‘Such evaluations shall include

8 evaluations of the extent to which States carrying

9 out such programs are in compliance with section

10 1501(a)(2) and with section 1504(c).’’; and

11 (2) in subsection (b), by inserting before the pe12 riod the following: ‘‘, including recommendations re13 garding compliance by the States with section

14 1501(a)(2) and with section 1504(c)’’.

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

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

17 amended—

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

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

20 ‘‘Control and Prevention,’’; and

21 (2) in section 1505—

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

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

24 and
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1 (B) in paragraph (4), by inserting ‘‘will’’

2 before ‘‘be used’’.

3 SEC. 3. ESTABLISHMENT OF DEMONSTRATION PROGRAM

4 OF GRANTS FOR ADDITIONAL PREVENTIVE

5 HEALTH SERVICES FOR WOMEN.

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

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

8 (1) by redesignating section 1509 as section

9 1510; and

10 (2) by inserting after section 1508 the following

11 section:

12 ‘‘SEC. 1509. SUPPLEMENTAL GRANTS FOR ADDITIONAL

13 PREVENTIVE HEALTH SERVICES.

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

15 States receiving grants under section 1501, the Secretary,

16 acting through the Director of the Centers for Disease

17 Control and Prevention, may make grants to not more

18 than 3 such States to carry out demonstration projects

19 for the purpose of—

20 ‘‘(1) providing preventive health services in ad21 dition to the services authorized in such section, in22 cluding screenings regarding blood pressure and cho23 lesterol, and including health education;

24 ‘‘(2) providing appropriate referrals for medical

25 treatment of women receiving services pursuant to
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1 paragraph (1) and ensuring, to the extent prac2 ticable, the provision of appropriate follow-up serv3 ices; and

4 ‘‘(3) evaluating activities conducted under para5 graphs (1) and (2) through appropriate surveillance

6 or program-monitoring activities.

7 ‘‘(b) STATUS AS PARTICIPANT IN PROGRAM REGARD8 ING BREAST AND CERVICAL CANCER.—The Secretary

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

10 State involved agrees that services under the grant will

11 be provided only through entities that are screening

12 women for breast or cervical cancer pursuant to a grant

13 under section 1501.

14 ‘‘(c) APPLICABILITY OF PROVISIONS OF GENERAL

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

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

17 title applies to a grant under section 1501.

18 ‘‘(d) FUNDING.—

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

20 for the purpose of carrying out this section, there

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

22 fiscal year 1994, and such sums as may be nec23 essary for each of the fiscal years 1995 through

24 1998.
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1 ‘‘(2) LIMITATION REGARDING FUNDING WITH

2 RESPECT TO BREAST AND CERVICAL CANCER.—The

3 authorization of appropriations established in para4 graph (1) is not effective for a fiscal year unless the

5 amount appropriated under section 1510(a) for the

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

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

8 the Public Health Service Act, as redesignated by sub9 section (a)(1) of this section, is amended in the heading

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

11 ‘‘FUNDING FOR GENERAL PROGRAM.’’.

12 SEC. 4. FUNDING FOR GENERAL PROGRAM.

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

14 redesignated by section 3(a)(2)) is amended—

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

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

17 ‘‘, $200,000,000 for fiscal year 1994, and such sums

18 as may be necessary for each of the fiscal years

19 1995 through 1998’’.

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