II 

112TH CONGRESS 

1ST SESSION S. 494 

To amend the Public Health Service Act to establish a national screening 

program at the Centers for Disease Control and Prevention and to 

amend title XIX of the Social Security Act to provide States the option 

to increase screening in the United States population for the prevention, 

early detection, and timely treatment of colorectal cancer. 

IN THE SENATE OF THE UNITED STATES 

MARCH 7, 2011 

Mr. LIEBERMAN (for himself and Mrs. HUTCHISON) introduced the following 

bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions 

A BILL 

To amend the Public Health Service Act to establish a national screening program at the Centers for Disease Control and Prevention and to amend title XIX of the Social 

Security Act to provide States the option to increase 

screening in the United States population for the prevention, early detection, and timely treatment of colorectal 

cancer. 

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


rfrederick on DSKD9S0YB1PROD with BILLS
2 

•S 494 IS

1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Colorectal Cancer Pre3 vention, Early Detection, and Treatment Act’’. 

4 SEC. 2. PREVENTIVE HEALTH MEASURES WITH RESPECT 

5 TO COLORECTAL CANCER. 

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

7 (42 U.S.C. 243 et seq.) is amended by inserting after sec8 tion 317T the following new section: 

9 ‘‘SEC. 317U. PREVENTIVE HEALTH MEASURES WITH RE10 SPECT TO COLORECTAL CANCER. 

11 ‘‘(a) GRANT PROGRAM AUTHORIZATION.— 

12 ‘‘(1) IN GENERAL.—The Secretary, acting 

13 through the Director of the Centers for Disease 

14 Control and Prevention, may make grants to eligible 

15 entities for the purpose of carrying out a program 

16 described in subsection (b). An eligible entity that is 

17 a recipient of a grant under this subsection may use 

18 such grant to carry out such programs directly or 

19 through grants to, or contracts with, public and not20 for-profit private entities. 

21 ‘‘(2) ELIGIBLE ENTITY DEFINED.—For pur22 poses of this section, the term ‘eligible entity’ in23 cludes the following: 

24 ‘‘(A) A State, including, in addition to the 

25 several States, the District of Columbia, Guam, 

26 the Commonwealth of Puerto Rico, the NorthVerDate Mar 15 2010 04:10 Mar 08, 2011 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S494.IS S494

rfrederick on DSKD9S0YB1PROD with BILLS
3 

•S 494 IS

1 ern Mariana Islands, the Virgin Islands, Amer2 ican Samoa, and the Trust Territory of the Pa3 cific Islands. 

4 ‘‘(B) An Indian tribe or tribal organiza5 tion, as such terms are defined in section 4 of 

6 the Indian Self-Determination and Education 

7 Assistance Act. 

8 ‘‘(b) PROGRAMS DESCRIBED.— 

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

10 program described in this subsection shall use evi11 dence-based strategies and population-based public 

12 health approaches, including public education and 

13 outreach, professional training and development, 

14 quality assurance monitoring, surveillance, and eval15 uation, to increase quality colorectal cancer screen16 ing in the population aged 50 years and older, or for 

17 individuals under 50 who are at high risk. A pro18 gram described in this subsection is a program for 

19 planning or implementing each of the following: 

20 ‘‘(A) Providing evidence-based, rec21 ommended screenings for colorectal cancer to 

22 individuals who— 

23 ‘‘(i) are 50 years of age or older; or 

24 ‘‘(ii)(I) are under 50 years of age; and 


rfrederick on DSKD9S0YB1PROD with BILLS
4 

•S 494 IS

1 ‘‘(II) are at high risk for such cancer, 

2 as determined in accordance with sub3 section (e)(2). 

4 ‘‘(B) Providing appropriate case manage5 ment and referrals for medical treatment of in6 dividuals screened pursuant to subparagraph 

7 (A). 

8 ‘‘(C) Ensuring (directly or through coordi9 nation or an arrangement with health care pro10 viders or programs) the full continuum of fol11 low-up and cancer care for individuals so 

12 screened, including appropriate follow-up for 

13 abnormal tests, diagnostic services, therapeutic 

14 services, and treatment of detected cancers and 

15 management of unanticipated medical complica16 tions. 

17 ‘‘(D) Carrying out activities to improve the 

18 education, training, and skills of health profes19 sionals (including allied health professionals) to 

20 ensure the use of evidence-based recommended 

21 and quality screening and follow up in the pre22 vention, detection, and control of colorectal can23 cer, which activities are carried out pursuant to 

24 the participation of the health professionals in 

25 the program. 


rfrederick on DSKD9S0YB1PROD with BILLS
5 

•S 494 IS

1 ‘‘(E) Establishing mechanisms through 

2 which the eligible entity involved can monitor 

3 the quality of screening and diagnostic follow4 up procedures for colorectal cancer, including 

5 the interpretation of such procedures. 

6 ‘‘(F) Evaluating the activities described in 

7 this subsection through appropriate surveillance 

8 and program monitoring activities. 

9 ‘‘(G) Developing and disseminating find10 ings derived through such evaluations and the 

11 collection of data on outcomes. 

12 ‘‘(H) Developing and disseminating public 

13 information and education programs for the 

14 prevention, detection, and control of colorectal 

15 cancer and promoting the benefits of receiving 

16 screenings to populations recommended for 

17 screening. 

18 ‘‘(2) SUPPLEMENT NOT SUPPLANT.—In the 

19 case of an eligible entity that implements a universal 

20 colorectal screening program under which the eligi21 ble entity makes available funds for activities de22 scribed in subparagraph (A), (B), or (C) of para23 graph (1), such entity shall be able to receive grant 

24 funds under subsection (a) only for purposes of— 


rfrederick on DSKD9S0YB1PROD with BILLS
6 

•S 494 IS

1 ‘‘(A) carrying out those activities under 

2 this subsection that are not so funded; or 

3 ‘‘(B) supplementing (and not supplanting) 

4 funds made available by the entity for such 

5 funded program. 

6 ‘‘(c) PRIORITY FOR LOW-INCOME, UNINSURED AND

7 UNDERINSURED INDIVIDUALS.—A grant may be made 

8 under subsection (a) to an eligible entity only if the eligible 

9 entity agrees that, in providing screenings under sub10 section (b)(1)(A), the eligible entity will give priority to 

11 low-income individuals who lack adequate coverage, as de12 termined by the Secretary, under health insurance and 

13 health plans with respect to screenings for colorectal can14 cer. 

15 ‘‘(d) SPECIAL CONSIDERATION FOR CERTAIN APPLI16 CANTS.—In making grants under subsection (a) for a fis17 cal year, the Secretary shall give special consideration to 

18 the following eligible entities: 

19 ‘‘(1) In the case of services under such sub20 section for women, to such entities that, for such 

21 year, are grantees under title XV. 

22 ‘‘(2) In the case of services under such sub23 section for men, to such entities that, for such year, 

24 are grantees under section 317D. 


rfrederick on DSKD9S0YB1PROD with BILLS
7 

•S 494 IS

1 ‘‘(3) To such entities that coordinate with other 

2 Federal, State, and local colorectal cancer programs. 

3 ‘‘(4) To such entities with an existing program 

4 to provide cancer screening to individuals. 

5 ‘‘(e) USE OF CERTAIN STANDARDS UNDER MEDI6 CARE PROGRAM.—A grant may be made under subsection 

7 (a) to an eligible entity only if the eligible entity provides, 

8 as applicable, assurances as follows: 

9 ‘‘(1) Screenings under subsection (b)(1)(A) will 

10 be carried out as preventive health measures in ac11 cordance with evidence-based screening guidelines 

12 and procedures and in accordance with the standard 

13 of care required for purposes of title XVIII of the 

14 Social Security Act to carry out colorectal screening 

15 tests defined in section 1861(pp)(1) of such Act. 

16 ‘‘(2) An individual will be considered high risk 

17 for purposes of subsection (b)(1)(A)(ii) only if the 

18 individual is high risk within the meaning of section 

19 1861(pp)(2) of such Act. 

20 ‘‘(3) The payment made from the grant for a 

21 screening procedure under subsection (b)(1)(A) will 

22 not exceed the amount that would be paid under 

23 part B of title XVIII of such Act if payment were 

24 made under such part for furnishing the procedure 

25 to an individual enrolled under such part. 


rfrederick on DSKD9S0YB1PROD with BILLS
8 

•S 494 IS

1 ‘‘(f) RELATIONSHIP TO ITEMS AND SERVICES UNDER

2 OTHER PROGRAMS.—A grant under subsection (a) may 

3 be made to an eligible entity only if the eligible entity, 

4 as applicable, provides assurances that the grant will not 

5 be expended to make payment for any item or service to 

6 the extent that payment has been made, or can reasonably 

7 be expected to be made, with respect to such item or serv8 ice— 

9 ‘‘(1) under any State compensation program, 

10 under an insurance policy, or under any Federal or 

11 State health benefits program; or 

12 ‘‘(2) by an entity that provides health services 

13 on a prepaid basis. 

14 ‘‘(g) RECORDS AND AUDITS.—A grant under sub15 section (a) may be made to an eligible entity only if the 

16 eligible entity provides assurances that the eligible entity 

17 will— 

18 ‘‘(1) establish such fiscal control and fund ac19 counting procedures as may be necessary to ensure 

20 proper disbursal of, and accounting for, amounts re21 ceived under subsection (a); and 

22 ‘‘(2) upon request, provide records maintained 

23 pursuant to paragraph (1) to the Secretary or the 

24 Comptroller General of the United States for purVerDate Mar 15 2010 04:10 Mar 08, 2011 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S494.IS S494

rfrederick on DSKD9S0YB1PROD with BILLS
9 

•S 494 IS

1 poses of auditing the expenditures of the grant by 

2 the eligible entity. 

3 ‘‘(h) REQUIREMENT OF MATCHING FUNDS.— 

4 ‘‘(1) IN GENERAL.—The Secretary may not 

5 make a grant under subsection (a) to an eligible en6 tity for a fiscal year unless the eligible entity agrees, 

7 with respect to the costs to be incurred by the eligi8 ble entity for such fiscal year in carrying out the ac9 tivities described in subsection (b), to make available 

10 non-Federal contributions (in cash or in kind under 

11 paragraph (2)) toward such costs in an amount 

12 equal to not less than $1 for each $3 of Federal 

13 funds provided in the grant for such fiscal year. 

14 Such contributions may be made directly or through 

15 donations from public or private entities. 

16 ‘‘(2) DETERMINATION OF AMOUNT OF NON17 FEDERAL CONTRIBUTION.— 

18 ‘‘(A) IN GENERAL.—Non-Federal contribu19 tions required in paragraph (1) may be in cash 

20 or in kind, fairly evaluated, including equipment 

21 or services (and excluding indirect or overhead 

22 costs). Amounts provided by the Federal Gov23 ernment, or services assisted or subsidized to 

24 any significant extent by the Federal GovernVerDate Mar 15 2010 04:10 Mar 08, 2011 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S494.IS S494

rfrederick on DSKD9S0YB1PROD with BILLS
10 

•S 494 IS

1 ment, may not be included in determining the 

2 amount of such non-Federal contributions. 

3 ‘‘(B) MAINTENANCE OF EFFORT.—In 

4 making a determination of the amount of non5 Federal contributions for purposes of paragraph 

6 (1), the Secretary may include only non-Federal 

7 contributions in excess of the average amount 

8 of non-Federal contributions made by the eligi9 ble entity involved toward the activities de10 scribed in subsection (b) for the 2-year period 

11 preceding the first fiscal year for which the eli12 gible entity is applying to receive a grant under 

13 subsection (a). 

14 ‘‘(C) INCLUSION OF RELEVANT NON-FED15 ERAL CONTRIBUTIONS FOR MEDICAID.—In 

16 making a determination of the amount of non17 Federal contributions for purposes of paragraph 

18 (1), the Secretary shall, subject to subpara19 graphs (A) and (B) of this paragraph, include 

20 any non-Federal amounts expended pursuant to 

21 title XIX of the Social Security Act by the eligi22 ble entity involved toward the activities de23 scribed in subparagraphs (A) and (B) of sub24 section (b)(1). 

25 ‘‘(i) ADDITIONAL REQUIREMENTS.— 


rfrederick on DSKD9S0YB1PROD with BILLS
11 

•S 494 IS

1 ‘‘(1) LIMITATION ON ADMINISTRATIVE EX2 PENSES.—The Secretary may not make a grant to 

3 an eligible entity under subsection (a) unless the eli4 gible entity provides assurances that not more than 

5 10 percent of the grant will be expended for admin6 istrative expenses with respect to the activities fund7 ed by the grant. 

8 ‘‘(2) STATEWIDE PROVISION OF SERVICES.— 

9 ‘‘(A) IN GENERAL.—Subject to subpara10 graph (B), the Secretary may not make a grant 

11 under subsection (a) to an eligible entity unless 

12 the eligible entity provides assurances that any 

13 program funded by such grant will be made 

14 available throughout the State, including avail15 ability to members of an Indian tribe or tribal 

16 organization (as such terms are defined in sec17 tion 4 of the Indian Self-Determination and 

18 Education Assistance Act). 

19 ‘‘(B) WAIVER.—The Secretary may waive 

20 the requirement under subparagraph (A) for an 

21 eligible entity if the Secretary determines that 

22 compliance by the eligible entity with the re23 quirement would result in an inefficient alloca24 tion of resources with respect to carrying out 

25 the purposes described in subsection (a). 


rfrederick on DSKD9S0YB1PROD with BILLS
12 

•S 494 IS

1 ‘‘(j) TECHNICAL ASSISTANCE AND PROVISION OF

2 SUPPLIES AND SERVICES IN LIEU OF GRANT FUNDS.— 

3 ‘‘(1) TECHNICAL ASSISTANCE.—The Secretary 

4 may provide training and technical assistance with 

5 respect to the planning, development, and operation 

6 of any program funded by a grant under subsection 

7 (a). The Secretary may provide such technical as8 sistance directly to eligible entities or through grants 

9 to, or contracts with, public and private entities. 

10 ‘‘(2) PROVISION OF SUPPLIES AND SERVICES IN

11 LIEU OF GRANT FUNDS.— 

12 ‘‘(A) IN GENERAL.—Subject to subpara13 graph (B), upon the request of an eligible entity 

14 receiving a grant under subsection (a), the Sec15 retary for the purpose of aiding the eligible en16 tity to carry out a program under subsection 

17 (b)— 

18 ‘‘(i) may provide supplies, equipment, 

19 and services to the eligible entity; and 

20 ‘‘(ii) may detail to the eligible entity 

21 any officer or employee of the Department 

22 of Health and Human Services. 

23 ‘‘(B) CORRESPONDING REDUCTION IN PAY24 MENTS.—With respect to a request made by an 

25 eligible entity under subparagraph (A), the SecVerDate Mar 15 2010 04:10 Mar 08, 2011 Jkt 099200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S494.IS S494

rfrederick on DSKD9S0YB1PROD with BILLS
13 

•S 494 IS

1 retary shall reduce the amount of payments 

2 made under the grant under subsection (a) to 

3 the eligible entity by an amount equal to the 

4 fair market value of any supplies, equipment, or 

5 services provided by the Secretary and the costs 

6 of detailing personnel (including pay, allow7 ances, and travel expenses) under subparagraph 

8 (A). The Secretary shall, for the payment of ex9 penses incurred in complying with such request, 

10 expend the amounts withheld. 

11 ‘‘(k) REPORTS.—A grant under subsection (a) may 

12 be made only if the applicant involved agrees to submit 

13 to the Secretary such reports as the Secretary may require 

14 with respect to the grant. 

15 ‘‘(l) AUTHORIZATION OF APPROPRIATIONS.— 

16 ‘‘(1) IN GENERAL.—For the purpose of car17 rying out this section, there are authorized to be ap18 propriated $75,000,000 for each of fiscal years 2012 

19 through 2016. 

20 ‘‘(2) SET-ASIDE FOR TECHNICAL ASSISTANCE

21 AND PROVISION OF SUPPLIES AND SERVICES.—Of 

22 the amount appropriated under paragraph (1) for a 

23 fiscal year, the Secretary shall reserve not to exceed 

24 20 percent for carrying out subsection (j).’’. 


rfrederick on DSKD9S0YB1PROD with BILLS
14 

•S 494 IS

1 SEC. 3. OPTIONAL MEDICAID COVERAGE OF CERTAIN PER2 SONS SCREENED AND FOUND TO HAVE 

3 COLORECTAL CANCER. 

4 (a) COVERAGE AS OPTIONAL CATEGORICALLY

5 NEEDY GROUP.— 

6 (1) IN GENERAL.—Section 1902(a)(10)(A)(ii) 

7 of the Social Security Act (42 U.S.C. 

8 1396a(a)(10)(A)(ii)) is amended— 

9 (A) in subclause (XXI), by striking ‘‘or’’ at 

10 the end; 

11 (B) in subclause (XXII), by adding ‘‘or’’ at 

12 the end; and 

13 (C) by adding at the end the following: 

14 ‘‘(XXIII) who are described in 

15 subsection (ll) (relating to certain per16 sons screened and found to need 

17 treatment from complications from 

18 screening or have colorectal cancer);’’. 

19 (2) GROUP DESCRIBED.—Section 1902 of the 

20 Social Security Act (42 U.S.C. 1396a) is amended 

21 by adding at the end the following: 

22 ‘‘(ll) Individuals described in this subsection are indi23 viduals who— 

24 ‘‘(1) are not described in subsection 

25 (a)(10)(A)(i); 

26 ‘‘(2) have not attained age 65; 


rfrederick on DSKD9S0YB1PROD with BILLS
15 

•S 494 IS

1 ‘‘(3) have been screened for colorectal cancer 

2 and need treatment for complications due to screen3 ing or colorectal cancer; and 

4 ‘‘(4) are not otherwise covered under creditable 

5 coverage, as defined in section 2704(c) of the Public 

6 Health Service Act.’’. 

7 (3) LIMITATION ON BENEFITS.—Section 

8 1902(a)(10) of the Social Security Act (42 U.S.C. 

9 1396a(a)(10)) is amended in the matter following 

10 subparagraph (G)— 

11 (A) by striking ‘‘(XV)’’ and inserting ‘‘, 

12 (XV)’’; 

13 (B) by striking ‘‘setting and (XVI)’’ and 

14 inserting ‘‘setting, (XVII)’’; and 

15 (C) by inserting ‘‘, and (XVIII) the med16 ical assistance made available to an individual 

17 described in subsection (ll) who is eligible for 

18 medical assistance only because of subpara19 graph (A)(10)(ii)(XXIII) shall be limited to 

20 medical assistance provided during the period in 

21 which such an individual requires treatment for 

22 complications due to screening or colorectal 

23 cancer’’ before the semicolon. 

24 (4) CONFORMING AMENDMENTS.—Section 

25 1905(a) of the Social Security Act (42 U.S.C. 


rfrederick on DSKD9S0YB1PROD with BILLS
16 

•S 494 IS

1 1396d(a)) is amended in the matter preceding para2 graph (1)— 

3 (A) in clause (xvi), by striking ‘‘or’’ at the 

4 end; 

5 (B) in clause (xvii), by adding ‘‘or’’ at the 

6 end; and 

7 (C) by inserting after clause (xvii) the fol8 lowing: 

9 ‘‘(xviii) individuals described in sec10 tion 1902(ll),’’. 

11 (b) PRESUMPTIVE ELIGIBILITY.— 

12 (1) IN GENERAL.—Title XIX of the Social Se13 curity Act (42 U.S.C. 1396 et seq.) is amended by 

14 inserting after section 1920C the following: 

15 ‘‘OPTIONAL APPLICATION OF PRESUMPTIVE ELIGIBILITY

16 PROVISIONS FOR CERTAIN PERSONS WITH

17 COLORECTAL CANCER

18 ‘‘SEC. 1920D. A State may elect to apply the provi19 sions of section 1920B to individuals described in section 

20 1902(ll) (relating to certain colorectal cancer patients) in 

21 the same manner as such section applies to individuals de22 scribed in section 1902(aa) (relating to certain breast or 

23 cervical cancer patients).’’. 

24 (2) CONFORMING AMENDMENTS.— 

25 (A) Section 1902(a)(47) of the Social Se26 curity Act (42 U.S.C. 1396a(a)(47)), as amendVerDate Mar 15 2010 04:10 Mar 08, 2011 Jkt 099200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\S494.IS S494

rfrederick on DSKD9S0YB1PROD with BILLS
17 

•S 494 IS

1 ed by sections 2202(a) and 2303(b)(2) of Pub2 lic Law 111–148, is amended— 

3 (i) in subparagraph (A), by inserting 

4 before the semicolon at the end the fol5 lowing: ‘‘ and provide for making medical 

6 assistance available to individuals described 

7 in section 1920D during a presumptive eli8 gibility period in accordance with such sec9 tion’’; and 

10 (ii) effective as of January 1, 2014, in 

11 subparagraph (B), by striking ‘‘or 1920C’’ 

12 and inserting ‘‘1920C, or 1920D’’. 

13 (B) Section 1903(u)(1)(D)(v) of such Act 

14 (42 U.S.C. 1396b(u)(1)(d)(v)) is amended by 

15 inserting ‘‘, or for medical assistance provided 

16 to an individual described in section 1920D 

17 during a presumptive eligibility period under 

18 such section’’ after ‘‘1920B during a presump19 tive eligibility period under such section’’. 

20 (c) ENHANCED MATCH.—The first sentence of sec21 tion 1905(b) of the Social Security Act (42 U.S.C. 

22 1396d(b)) is amended— 

23 (1) by striking ‘‘and’’ before ‘‘(4)’’; and 

24 (2) by inserting before the period at the end the 

25 following: ‘‘, and (5) the Federal medical assistance 


rfrederick on DSKD9S0YB1PROD with BILLS
18 

•S 494 IS

1 percentage shall be equal to the enhanced FMAP de2 scribed in section 2105(b) with respect to medical 

3 assistance provided to individuals who are eligible 

4 for such assistance only on the basis of section 

5 1902(a)(10)(A)(ii)(XXIII)’’. 

6 (d) EFFECTIVE DATE.—The amendments made by 

7 this section apply to medical assistance for items and serv8 ices furnished on or after October 1, 2011, without regard 

9 to whether final regulations to carry out such amendments 

10 have been promulgated by such date. 

Æ 


rfrederick on DSKD9S0YB1PROD with BILLS