II 

Calendar No. 100 

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, Mrs. HUTCHISON, Mr. HARKIN, Mr. DODD, Mr. 

KERRY, Mr. MENENDEZ, Mr. SCHUMER, Ms. COLLINS, Mr. BAYH, Mr. 

BIDEN, Mrs. CLINTON, Mrs. BOXER, Ms. SNOWE, Ms. STABENOW, Mr. 

ENZI, Mr. HATCH, and Mr. KENNEDY) introduced the following bill; 

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

MARCH 29, 2007 

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 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, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘National Breast and 

3 Cervical Cancer Early Detection Program Reauthorization 

4 Act of 2007’’. 

5 SEC. 2. NATIONAL BREAST AND CERVICAL CANCER EARLY 

6 DETECTION PROGRAM. 

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

8 300k et seq.) is amended— 

9 (1) in section 1501(d)— 

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

11 inserting ‘‘2020’’; and 

12 (B) by striking ‘‘by the year 2000’’ and in13 serting ‘‘by the year 2020’’; 

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

15 following: 

16 ‘‘(d) WAIVER OF SERVICES REQUIREMENT ON DIVI17 SION OF FUNDS.— 

18 ‘‘(1) IN GENERAL.—The Secretary shall estab19 lish a demonstration project under which the Sec20 retary, acting through the Director of the Centers 

21 for Disease Control and Prevention, may waive the 

22 requirements of paragraphs (1) and (4) of sub23 section (a) for not more than 5 States, if— 

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

25 waiver to leverage private funds to supplement 


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1 each of the services or activities described in 

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

3 ‘‘(ii) the application of such requirement 

4 would result in a barrier to the enrollment of 

5 qualifying women; 

6 ‘‘(B) the State involved provides assur7 ances that the State will, on an annual basis, 

8 demonstrate to the Secretary the manner in 

9 which the State will use such waiver to main10 tain or expand the level of screening and follow11 up services provided immediately prior to the 

12 waiver, and provide documentation of compli13 ance with such maintenance or expansion re14 quirement; 

15 ‘‘(C) the State involved submits to the Sec16 retary a plan for maintaining the level of activi17 ties carried out under the waiver after the expi18 ration of the waiver; 

19 ‘‘(D) the Secretary finds that granting 

20 such a waiver to a State will not reduce the 

21 number of women in the State that receive each 

22 of the services or activities described in para23 graphs (1) and (2) of section 1501(a), including 

24 making available screening procedures for both 

25 breast and cervical cancers; and 


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1 ‘‘(E) the Secretary finds that granting 

2 such a waiver to a State will not adversely af3 fect the quality of each of the services or activi4 ties described in paragraphs (1) and (2) of sec5 tion 1501(a). 

6 ‘‘(2) DURATION OF WAIVER.— 

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

8 under paragraph (1), the Secretary— 

9 ‘‘(i) shall grant such waivers for a pe10 riod of 2 years; and 

11 ‘‘(ii) upon request of a State, may ex12 tend a waiver for an additional 2-year pe13 riod in accordance with subparagraph (B). 

14 ‘‘(B) ADDITIONAL PERIOD.—The Sec15 retary, upon the request of a State that has re16 ceived a waiver under paragraph (1), shall, at 

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

18 subparagraph (A), review performance under 

19 the waiver and may extend the waiver for an 

20 additional 2-year period if the Secretary deter21 mines that— 

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

23 waiver, there will be a barrier to the enroll24 ment of qualifying women; or 


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1 ‘‘(II) the State requesting such ex2 tended waiver will use the waiver to lever3 age private funds to supplement the serv4 ices or activities described in paragraphs 

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

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

7 reduce the number of women in the State 

8 that receive the services or activities de9 scribed in paragraphs (1) and (2) of sec10 tion 1501(a); 

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

12 result in lower quality in the State of the 

13 services or activities described in para14 graphs (1) and (2) of section 1501(a); and 

15 ‘‘(iv) the State has maintained the av16 erage annual level of State fiscal expendi17 tures for the services and activities de18 scribed in paragraphs (1) and (2) of sec19 tion 1501(a) for the 2 years for which the 

20 waiver was granted at a level that is not 

21 less than the level of the State fiscal ex22 penditures for such services and activities 

23 for the year preceding the first year for 

24 which the waiver is granted. 


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1 ‘‘(3) REPORTING REQUIREMENTS.—The Sec2 retary shall include as part of the evaluations and 

3 reports required under section 1508, the following: 

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

5 dollars leveraged annually from private entities 

6 in States receiving a waiver under paragraph 

7 (1) and how these amounts were used. 

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

9 waiver under paragraph (1), a description of 

10 the percentage of the grant that is expended on 

11 providing each of the services or activities de12 scribed in— 

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

14 1501(a); and 

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

16 section 1501(a). 

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

18 receiving waivers under paragraph (1) annually. 

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

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

21 ‘‘(i) the number of women receiving 

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

23 of section 1501(a) in programs before and 

24 after the granting of such waiver; and 


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

2 fiscal expenditures for the services and ac3 tivities described in paragraphs (1) and (2) 

4 of section 1501(a) for the year preceding 

5 the first year for which the waiver was 

6 granted. 

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

8 applies under this subsection shall not be used to in9 crease the number of salaried employees. 

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

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

12 tribe’ has the meaning given the term in section 

13 4 of the Indian Health Care Improvement Act 

14 (25 U.S.C. 1603). 

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

16 ‘tribal organization’ has the meaning given the 

17 term in section 4 of the Indian Health Care Im18 provement Act. 

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

20 each of the several States of the United States, 

21 the District of Columbia, the Commonwealth of 

22 Puerto Rico, American Samoa, the Common23 wealth of the Northern Mariana Islands, the 

24 Republic of the Marshall Islands, the Federated 


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1 States of Micronesia, the Republic of Palau, an 

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

3 (3) in section 1508— 

4 (A) in subsection (a), by striking ‘‘evalua5 tions of the extent to which’’ and all that fol6 lows through the period and inserting: ‘‘evalua7 tions of— 

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

9 such programs are in compliance with section 

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

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

12 grant under this title is in compliance with section 

13 1502, including identification of— 

14 ‘‘(A) the amount of the non-Federal con15 tributions by the State for the preceding fiscal 

16 year, disaggregated according to the source of 

17 the contributions; and 

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

19 non-Federal contributions relative to the 

20 amount of Federal funds provided through the 

21 grant to the State for the preceding fiscal 

22 year.’’; and 

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

24 later than 1 year after the date on which 

25 amounts are first appropriated pursuant to secVerDate Aug 31 2005 04:59 Mar 30, 2007 Jkt 059200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6401 E:\BILLS\S624.RS S624

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1 tion 1509(a), and annually thereafter’’ and in2 serting ‘‘not later than 1 year after the date of 

3 the enactment of the National Breast and Cer4 vical Cancer Early Detection Program Reau5 thorization of 2007, and annually thereafter’’; 

6 and 

7 (4) in section 1510(a)— 

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

9 for fiscal year 1994,’’; and 

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

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

12 $250,000,000 for fiscal year 2010, 

13 $255,000,000 for fiscal year 2011, and 

14 $275,000,000 for fiscal year 2012’’ before the 

15 period at the end. 

16 SECTION 1. SHORT TITLE. 

17 This Act may be cited as the ‘‘National Breast and 

18 Cervical Cancer Early Detection Program Reauthorization 

19 Act of 2007’’. 

20 SEC. 2. NATIONAL BREAST AND CERVICAL CANCER EARLY 

21 DETECTION PROGRAM. 

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

23 300k et seq.) is amended— 

24 (1) in section 1501(d)— 


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

2 inserting ‘‘2020’’; and 

3 (B) by striking ‘‘by the year 2000’’ and in4 serting ‘‘by the year 2020’’; 

5 (2) in section 1503, by adding at the end the fol6 lowing: 

7 ‘‘(d) WAIVER OF SERVICES REQUIREMENT ON DIVI8 SION OF FUNDS.— 

9 ‘‘(1) IN GENERAL.—The Secretary shall establish 

10 a demonstration project under which the Secretary 

11 may waive the requirements of paragraphs (1) and 

12 (4) of subsection (a) for not more than 5 States, if— 

13 ‘‘(A) the State involved will use the waiver 

14 to leverage non-Federal funds to supplement each 

15 of the services or activities described in para16 graphs (1) and (2) of section 1501(a); 

17 ‘‘(B) the application of such requirement 

18 would result in a barrier to the enrollment of 

19 qualifying women; 

20 ‘‘(C) the State involved— 

21 ‘‘(i) demonstrates, to the satisfaction of 

22 the Secretary, the manner in which the 

23 State will use such waiver to expand the 

24 level of screening and follow-up services proVerDate Aug 31 2005 04:59 Mar 30, 2007 Jkt 059200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6203 E:\BILLS\S624.RS S624

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1 vided immediately prior to the date on 

2 which the waiver is granted; and 

3 ‘‘(ii) provides assurances, satisfactory 

4 to the Secretary, that the State will, on an 

5 annual basis, demonstrate, through such 

6 documentation as the Secretary may re7 quire, that the State has used such waiver 

8 as described in clause (i); 

9 ‘‘(D) the State involved submits to the Sec10 retary— 

11 ‘‘(i) assurances, satisfactory to the Sec12 retary, that the State will maintain the av13 erage annual level of State fiscal year ex14 penditures for the services and activities de15 scribed in paragraphs (1) and (2) of section 

16 1501(a) for the period for which the waiver 

17 is granted, and for the period for which any 

18 extension of such wavier is granted, at a 

19 level that is not less than— 

20 ‘‘(I) the level of the State fiscal 

21 year expenditures for such services and 

22 activities for the fiscal year preceding 

23 the first fiscal year for which the waiv24 er is granted; or 


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1 ‘‘(II) at the option of the State 

2 and upon approval by the Secretary, 

3 the average level of the State expendi4 tures for such services and activities 

5 for the 3-fiscal year period preceding 

6 the first fiscal year for which the waiv7 er is granted; and 

8 ‘‘(ii) a plan, satisfactory to the Sec9 retary, for maintaining the level of activi10 ties carried out under the waiver after the 

11 expiration of the waiver and any extension 

12 of such waiver; 

13 ‘‘(E) the Secretary finds that granting such 

14 a waiver to a State will increase the number of 

15 women in the State that receive each of the serv16 ices or activities described in paragraphs (1) and 

17 (2) of section 1501(a), including making avail18 able screening procedures for both breast and cer19 vical cancers; and 

20 ‘‘(F) the Secretary finds that granting such 

21 a waiver to a State will not adversely affect the 

22 quality of each of the services or activities de23 scribed in paragraphs (1) and (2) of section 

24 1501(a). 

25 ‘‘(2) DURATION OF WAIVER.— 


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

2 under paragraph (1), the Secretary— 

3 ‘‘(i) shall grant such waivers for a pe4 riod that is not less than 1 year but not 

5 more than 2 years; and 

6 ‘‘(ii) upon request of a State, may ex7 tend a waiver for an additional period that 

8 is not less than 1 year but not more than 

9 2 years in accordance with subparagraph 

10 (B). 

11 ‘‘(B) ADDITIONAL PERIOD.—The Secretary, 

12 upon the request of a State that has received a 

13 waiver under paragraph (1), shall, at the end of 

14 the waiver period described in subparagraph 

15 (A)(i), review performance under the waiver and 

16 may extend the waiver for an additional period 

17 if the Secretary determines that— 

18 ‘‘(i) without an extension of the waiv19 er, there will be a barrier to the enrollment 

20 of qualifying women; 

21 ‘‘(ii) the State requesting such extended 

22 waiver will use the waiver to leverage non23 Federal funds to supplement the services or 

24 activities described in paragraphs (1) and 

25 (2) of section 1501(a); 


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1 ‘‘(iii) the waiver has increased, and 

2 will continue to increase, the number of 

3 women in the State that receive the services 

4 or activities described in paragraphs (1) 

5 and (2) of section 1501(a); 

6 ‘‘(iv) 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 ‘‘(v) the State has maintained the av11 erage annual level of State fiscal expendi12 tures for the services and activities described 

13 in paragraphs (1) and (2) of section 

14 1501(a) for the period for which the waiver 

15 was granted at a level that is not less 

16 than— 

17 ‘‘(I) the level of the State fiscal 

18 year expenditures for such services and 

19 activities for the fiscal year preceding 

20 the first fiscal year for which the waiv21 er is granted; or 

22 ‘‘(II) at the option of the State 

23 and upon approval by the Secretary, 

24 the average level of the State expendi25 tures for such services and activities 


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1 for the 3-fiscal year period preceding 

2 the first fiscal year for which the waiv3 er is granted. 

4 ‘‘(3) REPORTING REQUIREMENTS.—The Sec5 retary shall include as part of the evaluations and re6 ports required under section 1508, the following: 

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

8 dollars leveraged annually from Non-Federal en9 tities in States receiving a waiver under para10 graph (1) and how these amounts were used. 

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

12 waiver under paragraph (1), a description of the 

13 percentage of the grant that is expended on pro14 viding each of the services or activities described 

15 in— 

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

17 1501(a); and 

18 ‘‘(ii) paragraphs (3) through (6) of sec19 tion 1501(a). 

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

21 receiving waivers under paragraph (1) annually. 

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

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

24 ‘‘(i) the number of women receiving 

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


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1 of section 1501(a) in programs before and 

2 after the granting of such waiver; and 

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

4 fiscal expenditures for the services and ac5 tivities described in paragraphs (1) and (2) 

6 of section 1501(a) for the year preceding the 

7 first year for which the waiver was granted. 

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

9 applies under this subsection shall not be used to in10 crease the number of salaried employees. 

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

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

13 tribe’ has the meaning given the term in section 

14 4 of the Indian Health Care Improvement Act 

15 (25 U.S.C. 1603). 

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

17 ‘tribal organization’ has the meaning given the 

18 term in section 4 of the Indian Health Care Im19 provement Act. 

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

21 of the several States of the United States, the 

22 District of Columbia, the Commonwealth of 

23 Puerto Rico, American Samoa, the Common24 wealth of the Northern Mariana Islands, the Re25 public of the Marshall Islands, the Federated 


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1 States of Micronesia, the Republic of Palau, an 

2 Indian tribe, and a tribal organization. 

3 ‘‘(6) SUNSET.—The Secretary may not grant a 

4 waiver or extension under this subsection after Sep5 tember 30, 2012.’’; 

6 (3) in section 1508— 

7 (A) in subsection (a), by striking ‘‘evalua8 tions of the extent to which’’ and all that follows 

9 through the period and inserting: ‘‘evaluations 

10 of— 

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

12 programs are in compliance with section 1501(a)(2) 

13 and with section 1504(c); and 

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

15 grant under this title is in compliance with section 

16 1502, including identification of— 

17 ‘‘(A) the amount of the non-Federal con18 tributions by the State for the preceding fiscal 

19 year, disaggregated according to the source of the 

20 contributions; and 

21 ‘‘(B) the proportion of such amount of non22 Federal contributions relative to the amount of 

23 Federal funds provided through the grant to the 

24 State for the preceding fiscal year.’’; and 


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1 (B) in subsection (b), by striking ‘‘not later 

2 than 1 year after the date on which amounts are 

3 first appropriated pursuant to section 1509(a), 

4 and annually thereafter’’ and inserting ‘‘not 

5 later than 1 year after the date of the enactment 

6 of the National Breast and Cervical Cancer 

7 Early Detection Program Reauthorization of 

8 2007, and annually thereafter’’; and 

9 (4) in section 1510(a)— 

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

11 for fiscal year 1994,’’; and 

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

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

14 $250,000,000 for fiscal year 2010, $255,000,000 

15 for fiscal year 2011, and $275,000,000 for fiscal 

16 year 2012’’ before the period at the end. 


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Calendar No. 100 

110TH CONGRESS 

1ST SESSION S. 624 

A BILL 

To amend the Public Health Service Act to provide 

cers. measures with respect to breast and cervical canwaivers relating to grants for preventive health 

MARCH 29, 2007 

Reported with an amendment 


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