II 

110TH CONGRESS 

1ST SESSION S. 624 

To amend the Public Health Service Act to provide waivers relating to 

grants for preventive health measures with respect to breast and cervical 

cancers. 

IN THE SENATE OF THE UNITED STATES 

FEBRUARY 15, 2007 

Ms. MIKULSKI (for herself 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 provide waivers 

relating to grants for preventive health measures with 

respect to breast and cervical cancers. 

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 ‘‘National Breast and 

5 Cervical Cancer Early Detection Program Reauthorization 

6 Act of 2007’’. 


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1 SEC. 2. NATIONAL BREAST AND CERVICAL CANCER EARLY 

2 DETECTION PROGRAM. 

3 Title XV of the Public Health Service Act (42 U.S.C. 

4 300k et seq.) is amended— 

5 (1) in section 1501(d)— 

6 (A) in the heading, by striking ‘‘2000’’ and 

7 inserting ‘‘2020’’; and 

8 (B) by striking ‘‘by the year 2000’’ and in9 serting ‘‘by the year 2020’’; 

10 (2) in section 1503, by adding at the end the 

11 following: 

12 ‘‘(d) WAIVER OF SERVICES REQUIREMENT ON DIVI13 SION OF FUNDS.— 

14 ‘‘(1) IN GENERAL.—The Secretary shall estab15 lish a demonstration project under which the Sec16 retary, acting through the Director of the Centers 

17 for Disease Control and Prevention, may waive the 

18 requirements of paragraphs (1) and (4) of sub19 section (a) for not more than 5 States, if— 

20 ‘‘(A)(i) the State involved will use the 

21 waiver to leverage private funds to supplement 

22 each of the services or activities described in 

23 paragraphs (1) and (2) of section 1501(a); or 

24 ‘‘(ii) the application of such requirement 

25 would result in a barrier to the enrollment of 

26 qualifying women; 


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1 ‘‘(B) the State involved provides assur2 ances that the State will, on an annual basis, 

3 demonstrate to the Secretary the manner in 

4 which the State will use such waiver to main5 tain or expand the level of screening and follow6 up services provided immediately prior to the 

7 waiver, and provide documentation of compli8 ance with such maintenance or expansion re9 quirement; 

10 ‘‘(C) the State involved submits to the Sec11 retary a plan for maintaining the level of activi12 ties carried out under the waiver after the expi13 ration of the waiver; 

14 ‘‘(D) the Secretary finds that granting 

15 such a waiver to a State will not reduce the 

16 number of women in the State that receive each 

17 of the services or activities described in para18 graphs (1) and (2) of section 1501(a), including 

19 making available screening procedures for both 

20 breast and cervical cancers; and 

21 ‘‘(E) the Secretary finds that granting 

22 such a waiver to a State will not adversely af23 fect the quality of each of the services or activi24 ties described in paragraphs (1) and (2) of sec25 tion 1501(a). 


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1 ‘‘(2) DURATION OF WAIVER.— 

2 ‘‘(A) IN GENERAL.—In granting waivers 

3 under paragraph (1), the Secretary— 

4 ‘‘(i) shall grant such waivers for a pe5 riod of 2 years; and 

6 ‘‘(ii) upon request of a State, may ex7 tend a waiver for an additional 2-year pe8 riod in accordance with subparagraph (B). 

9 ‘‘(B) ADDITIONAL PERIOD.—The Sec10 retary, upon the request of a State that has re11 ceived a waiver under paragraph (1), shall, at 

12 the end of the 2-year waiver period described in 

13 subparagraph (A), review performance under 

14 the waiver and may extend the waiver for an 

15 additional 2-year period if the Secretary deter16 mines that— 

17 ‘‘(i)(I) without an extension of the 

18 waiver, there will be a barrier to the enroll19 ment of qualifying women; or 

20 ‘‘(II) the State requesting such ex21 tended waiver will use the waiver to lever22 age private funds to supplement the serv23 ices or activities described in paragraphs 

24 (1) and (2) of section 1501(a); 


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1 ‘‘(ii) the waiver has not, and will not, 

2 reduce the number of women in the State 

3 that receive the services or activities de4 scribed in paragraphs (1) and (2) of sec5 tion 1501(a); 

6 ‘‘(iii) the waiver has not, and will not, 

7 result in lower quality in the State of the 

8 services or activities described in para9 graphs (1) and (2) of section 1501(a); and 

10 ‘‘(iv) the State has maintained the av11 erage annual level of State fiscal expendi12 tures for the services and activities de13 scribed in paragraphs (1) and (2) of sec14 tion 1501(a) for the 2 years for which the 

15 waiver was granted at a level that is not 

16 less than the level of the State fiscal ex17 penditures for such services and activities 

18 for the year preceding the first year for 

19 which the waiver is granted. 

20 ‘‘(3) REPORTING REQUIREMENTS.—The Sec21 retary shall include as part of the evaluations and 

22 reports required under section 1508, the following: 

23 ‘‘(A) A description of the total amount of 

24 dollars leveraged annually from private entities 


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1 in States receiving a waiver under paragraph 

2 (1) and how these amounts were used. 

3 ‘‘(B) With respect to States receiving a 

4 waiver under paragraph (1), a description of 

5 the percentage of the grant that is expended on 

6 providing each of the services or activities de7 scribed in— 

8 ‘‘(i) paragraphs (1) and (2) of section 

9 1501(a); and 

10 ‘‘(ii) paragraphs (3) through (6) of 

11 section 1501(a). 

12 ‘‘(C) A description of the number of States 

13 receiving waivers under paragraph (1) annually. 

14 ‘‘(D) With respect to States receiving a 

15 waiver under paragraph (1), a description of— 

16 ‘‘(i) the number of women receiving 

17 services under paragraphs (1), (2), and (3) 

18 of section 1501(a) in programs before and 

19 after the granting of such waiver; and 

20 ‘‘(ii) the average annual level of State 

21 fiscal expenditures for the services and ac22 tivities described in paragraphs (1) and (2) 

23 of section 1501(a) for the year preceding 

24 the first year for which the waiver was 

25 granted. 


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1 ‘‘(4) LIMITATION.—Amounts to which a waiver 

2 applies under this subsection shall not be used to in3 crease the number of salaried employees. 

4 ‘‘(5) DEFINITIONS.—In this subsection: 

5 ‘‘(A) INDIAN TRIBE.—The term ‘Indian 

6 tribe’ has the meaning given the term in section 

7 4 of the Indian Health Care Improvement Act 

8 (25 U.S.C. 1603). 

9 ‘‘(B) TRIBAL ORGANIZATION.—The term 

10 ‘tribal organization’ has the meaning given the 

11 term in section 4 of the Indian Health Care Im12 provement Act. 

13 ‘‘(C) STATE.—The term ‘State’ means 

14 each of the several States of the United States, 

15 the District of Columbia, the Commonwealth of 

16 Puerto Rico, American Samoa, the Common17 wealth of the Northern Mariana Islands, the 

18 Republic of the Marshall Islands, the Federated 

19 States of Micronesia, the Republic of Palau, an 

20 Indian tribe, and a tribal organization.’’; 

21 (3) in section 1508— 

22 (A) in subsection (a), by striking ‘‘evalua23 tions of the extent to which’’ and all that fol24 lows through the period and inserting: ‘‘evalua25 tions of— 


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1 ‘‘(1) the extent to which States carrying out 

2 such programs are in compliance with section 

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

4 ‘‘(2) the extent to which each State receiving a 

5 grant under this title is in compliance with section 

6 1502, including identification of— 

7 ‘‘(A) the amount of the non-Federal con8 tributions by the State for the preceding fiscal 

9 year, disaggregated according to the source of 

10 the contributions; and 

11 ‘‘(B) the proportion of such amount of 

12 non-Federal contributions relative to the 

13 amount of Federal funds provided through the 

14 grant to the State for the preceding fiscal 

15 year.’’; and 

16 (B) in subsection (b), by striking ‘‘not 

17 later than 1 year after the date on which 

18 amounts are first appropriated pursuant to sec19 tion 1509(a), and annually thereafter’’ and in20 serting ‘‘not later than 1 year after the date of 

21 the enactment of the National Breast and Cer22 vical Cancer Early Detection Program Reau23 thorization of 2007, and annually thereafter’’; 

24 and 

25 (4) in section 1510(a)— 


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1 (A) by striking ‘‘and’’ after ‘‘$150,000,000 

2 for fiscal year 1994,’’; and 

3 (B) by inserting ‘‘, $225,000,000 for fiscal 

4 year 2008, $245,000,000 for fiscal year 2009, 

5 $250,000,000 for fiscal year 2010, 

6 $255,000,000 for fiscal year 2011, and 

7 $275,000,000 for fiscal year 2012’’ before the 

8 period at the end. 

Æ 


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