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[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[S. 1415 Introduced in Senate (IS)]

110th CONGRESS
  1st Session
                                S. 1415

 To amend the Public Health Service Act and the Social Security Act to 
 improve screening and treatment of cancers, provide for survivorship 
                   services, and for other purposes.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                              May 16, 2007

 Mr. Harkin (for himself and Ms. Snowe) introduced the following bill; 
     which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL

 
 To amend the Public Health Service Act and the Social Security Act to 
 improve screening and treatment of cancers, provide for survivorship 
                   services, and for other purposes.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Cancer Screening, Treatment, and 
Survivorship Act of 2007''.

SEC. 2. ESTABLISHMENT OF PROGRAM OF GRANTS FOR DETECTION AND CONTROL OF 
              CERTAIN CANCERS.

    The Public Health Service Act (42 U.S.C. 201 et seq.) is amended by 
inserting after title XXIX the following new title:

   ``TITLE XXX--PREVENTIVE HEALTH AND EARLY DETECTION MEASURES WITH 
                           RESPECT TO CANCERS

``SEC. 3001. ESTABLISHMENT OF PROGRAM.

    ``(a) Grants.--
            ``(1) In general.--The Secretary, acting through the 
        Director of the Centers for Disease Control and Prevention, 
        shall make grants to eligible entities on a competitive basis 
        for the purpose of carrying out a program--
                    ``(A) to screen for cancer utilizing a screening 
                method or technology that receives a recommendation of 
                `B' or `A' from the Preventive Services Task Force 
                convened under section 915 (in this subsection referred 
                to as a `USPSTF recommended screening method or 
                technology') and for which the Secretary has made a 
                determination of eligibility for grant funding based on 
                criteria developed by the Secretary, to achieve maximum 
                benefits from the funds available, that includes--
                            ``(i) the prevalence of the cancer in the 
                        population;
                            ``(ii) the mortality and morbidity 
                        attributed to that cancer;
                            ``(iii) the predictive value of the 
                        screening diagnostic;
                            ``(iv) the cost of the screening 
                        diagnostic;
                            ``(v) the current demonstrated efficacy of 
                        treatment when the diagnostic procedure 
                        identifies the cancer; and
                            ``(vi) the estimated overall cost-benefit 
                        projected for application of the diagnostic;
                    ``(B) to provide appropriate referrals for medical 
                treatment of individuals screened pursuant to 
                subparagraph (A) and to ensure, to the extent 
                practicable, the provision of appropriate follow-up 
                services;
                    ``(C) to develop and disseminate public information 
                and education programs for the detection and control of 
                those cancers for which there exists a USPSTF 
                recommended screening method or technology;
                    ``(D) to improve the education, training, and 
                skills of health professionals (including allied health 
                professionals) in the detection and control of those 
                cancers for which there exists a USPSTF recommended 
                screening method or technology;
                    ``(E) to establish mechanisms through which 
                eligible entities can monitor the quality of screening 
                procedures for those cancers for which there exists a 
                USPSTF recommended screening method or technology, 
                including the interpretation of such procedures; and
                    ``(F) to evaluate activities conducted under 
                subparagraphs (A) through (E) through appropriate 
                surveillance or program-monitoring activities.
            ``(2) Eligible entity defined.--For purposes of this 
        section, the term `eligible entity' includes the following:
                    ``(A) A State, including, in addition to the 
                several States, the District of Columbia, Guam, the 
                Commonwealth of Puerto Rico, the Northern Mariana 
                Islands, the Virgin Islands, American Samoa, and the 
                Trust Territory of the Pacific Islands.
                    ``(B) An Indian tribe or tribal organization, as 
                such terms are defined in section 4 of the Indian Self-
                Determination and Education Assistance Act.
            ``(3) Rankings.--The Secretary may rank approved screening 
        methods or technologies under paragraph (1)(A) as a factor to 
        consider in awarding grants under paragraph (1).
    ``(b) Grant and Contract Authority.--An eligible entity receiving a 
grant under subsection (a) may expend the grant to carry out the 
purpose described in such subsection through grants to, and contracts 
with, public or nonprofit private entities.
    ``(c) Initial Demonstration Period.--In each of fiscal years 2008 
through 2010, the Secretary shall make a grant under subsection (a) to 
no fewer than 5 eligible entities. Each such grant shall be for 
purposes of developing best practices and methods for implementing a 
program described in such subsection.
    ``(d) Program Expansion.--Beginning in fiscal year 2011, the 
limitation on grant awards contained in subsection (c) shall terminate, 
and grants shall be awarded subject to availability of appropriations 
under conditions established by the Secretary and consistent with the 
provisions of this title.

``SEC. 3002. REQUIREMENT OF MATCHING FUNDS.

    ``(a) In General.--The Secretary may not make a grant under section 
3001 unless the eligible entity involved agrees, with respect to the 
costs to be incurred by the eligible entity in carrying out the purpose 
described in such section, to make available non-Federal contributions 
(in cash or in kind under subsection (b)) toward such costs in an 
amount that is not less than $1 for each $3 of Federal funds provided 
in the grant. Such contributions may be made directly or through 
donations from public or private entities.
    ``(b) Determination of Amount of Non-Federal Contribution.--
            ``(1) In general.--Non-Federal contributions required in 
        subsection (a) may be in cash or in kind, fairly evaluated, 
        including equipment or services (and excluding indirect or 
        overhead costs). Amounts provided by the Federal Government, or 
        services assisted or subsidized to any significant extent by 
        the Federal Government, may not be included in determining the 
        amount of such non-Federal contributions.
            ``(2) Maintenance of effort.--In making a determination of 
        the amount of non-Federal contributions for purposes of 
        subsection (a), the Secretary may include only non-Federal 
        contributions in excess of the average amount of non-Federal 
        contributions made by the eligible entity involved toward the 
        purpose described in section 3001(a)(1) for the 2-year period 
        preceding the first fiscal year for which the eligible entity 
        is applying to receive a grant under such section.
            ``(3) Inclusion of relevant non-federal contributions for 
        medicaid.--In making a determination of the amount of non-
        Federal contributions for purposes of subsection (a), the 
        Secretary shall, subject to paragraphs (1) and (2) of this 
        subsection, include any non-Federal amounts expended pursuant 
        to title XIX of the Social Security Act by the eligible entity 
        involved toward the purpose described in subparagraphs (A) and 
        (B) of section 3001(a)(1).

``SEC. 3003. REQUIREMENTS WITH RESPECT TO TYPE AND QUALITY OF SERVICES.

    ``(a) Requirement of Provision of All Services by Date Certain.--
The Secretary may not make a grant under section 3001 unless the 
eligible entity involved agrees--
            ``(1) to ensure that, initially and throughout the period 
        during which amounts are received pursuant to the grant, not 
        less than 60 percent of the grant is expended to provide each 
        of the services or activities described in subparagraphs (A) 
        and (B) of section 3001(a)(1), including making available 
        screening procedures for those cancers for which there exists a 
        USPSTF recommended screening method or technology;
            ``(2) to ensure that, by the end of any second fiscal year 
        of payments pursuant to the grant, each of the services or 
        activities described in section 3001(a)(1) is provided; and
            ``(3) to ensure that not more than 40 percent of the grant 
        is expended to provide the services or activities described in 
        subparagraphs (C) through (F) of such section.
    ``(b) Quality Assurance Regarding Screening for Additional Forms of 
Cancer.--The Secretary may not make a grant under section 3001 unless 
the eligible entity involved--
            ``(1) assures the quality of any screening procedure for 
        those cancers for which there exists conducted pursuant to such 
        section; and
            ``(2) assures that, with respect to the first cancer 
        screening performed on an individual for which payment is made 
        pursuant to section 3001(a)(1), there are satisfactory 
        assurances that the results of the screening will be placed in 
        permanent medical records maintained with respect to the 
        individual.
    ``(c) Issuance by Secretary of Guidelines With Respect to Quality 
of Cancer Services.--
            ``(1) In general.--The Secretary shall issue guidelines for 
        assuring the quality of any cancer screening procedure 
        conducted pursuant to section 3001(a)(1).
            ``(2) Applicability with respect to grants.--The Secretary 
        may not make a grant under section 3001 unless the eligible 
        entity involved agrees that the eligible entity will, with 
        respect to any cancer screening procedure conducted pursuant to 
        such section, ensure that the procedure is conducted in 
        accordance with the guidelines issued by the Secretary under 
        paragraph (1).

``SEC. 3004. ADDITIONAL REQUIRED AGREEMENTS.

    ``(a) Priority for Low-Income Individuals.--The Secretary may not 
make a grant under section 3001 unless the eligible entity involved 
agrees that low-income individuals will be given priority in the 
provision of services and activities pursuant to subparagraphs (A) and 
(B) of section 3001(a)(1).
    ``(b) Limitation on Imposition of Fees for Services.--The Secretary 
may not make a grant under section 3001 unless the eligible entity 
involved agrees that, if a charge is imposed for the provision of 
services or activities under the grant, such charge--
            ``(1) will be made according to a schedule of charges that 
        is made available to the public;
            ``(2) will be adjusted to reflect the income of the 
        individuals involved; and
            ``(3) will not be imposed on any individual with an income 
        of less than 100 percent of the official poverty line, as 
        established by the Director of the Office of Management and 
        Budget and revised by the Secretary in accordance with section 
        673(2) of the Omnibus Budget Reconciliation Act of 1981.
    ``(c) Statewide Provision of Services.--
            ``(1) In general.--In the case of an eligible entity 
        described in section 3001(a)(2)(A), the Secretary may not make 
        a grant under section 3001 unless the eligible entity agrees 
        that services and activities under the grant will be made 
        available throughout the State, including availability to 
        members of any Indian tribe or tribal organization (as such 
        terms are defined in section 4 of the Indian Self-Determination 
        and Education Assistance Act).
            ``(2) Waiver.--The Secretary may waive the requirement 
        established in paragraph (1) for an eligible entity if the 
        Secretary determines that compliance by the eligible entity 
        with the requirement would result in an inefficient allocation 
        of resources with respect to carrying out the purpose described 
        in section 3001(a)(1).
    ``(d) Relationship to Items and Services Under Other Programs.--The 
Secretary may not make a grant under section 3001 unless the eligible 
entity involved agrees that the grant will not be expended to make 
payment for any item or service to the extent that payment has been 
made, or can reasonably be expected to be made, with respect to such 
item or service--
            ``(1) under any State compensation program, under an 
        insurance policy, or under any Federal or State health benefits 
        program; or
            ``(2) by an entity that provides health services on a 
        prepaid basis.
    ``(e) Coordination With Other Cancer Programs.--The Secretary may 
not make a grant under section 3001 unless the eligible entity involved 
agrees that the services and activities funded through the grant will 
be coordinated with other Federal, State, and local cancer programs.
    ``(f) Limitation on Administrative Expenses.--The Secretary may not 
make a grant under section 3001 unless the eligible entity involved 
agrees that not more than 10 percent of the grant will be expended for 
administrative expenses with respect to the grant.
    ``(g) Restrictions on Use of Grant.--The Secretary may not make a 
grant under section 3001 unless the eligible entity involved agrees 
that the grant will not be expended to provide inpatient hospital 
services (as that term is defined by the Secretary for purposes of this 
subsection).
    ``(h) Records and Audits.--The Secretary may not make a grant under 
section 3001 unless the eligible entity involved agrees that--
            ``(1) the eligible entity will establish such fiscal 
        control and fund accounting procedures as may be necessary to 
        ensure the proper disbursement of, and accounting for, amounts 
        received by the eligible entity under such section; and
            ``(2) upon request, the eligible entity will provide 
        records maintained pursuant to paragraph (1) to the Secretary 
        or the Comptroller General of the United States for purposes of 
        auditing the expenditures by the eligible entity of the grant.
    ``(i) Reports to Secretary.--The Secretary may not make a grant 
under section 3001 unless the eligible entity involved agrees to submit 
to the Secretary such reports as the Secretary may require with respect 
to the grant.

``SEC. 3005. DESCRIPTION OF INTENDED USES OF GRANT.

    ``The Secretary may not make a grant under section 3001 unless--
            ``(1) the eligible entity involved submits to the Secretary 
        a description of the purposes for which the eligible entity 
        intends to expend the grant;
            ``(2) the description identifies the populations, areas, 
        and localities in the eligible entity with a need for the 
        services or activities described in section 3001(a)(1);
            ``(3) the description provides information relating to the 
        services and activities to be provided, including a description 
        of the manner in which the services and activities will be 
        coordinated with any similar services or activities of public 
        or nonprofit entities; and
            ``(4) the description provides assurances that the grant 
        funds be used in the most cost-effective manner.

``SEC. 3006. REQUIREMENT OF SUBMISSION OF APPLICATION.

    ``The Secretary may not make a grant under section 3001 unless an 
application for the grant is submitted to the Secretary, the 
application contains the description of intended uses required in 
section 3005, and the application is in such form, is made in such 
manner, and contains such agreements, assurances, and information as 
the Secretary determines to be necessary to carry out this title.

``SEC. 3007. TECHNICAL ASSISTANCE AND PROVISION OF SUPPLIES AND 
              SERVICES IN LIEU OF GRANT FUNDS.

    ``(a) Technical Assistance.--The Secretary may provide training and 
technical assistance with respect to the planning, development, and 
operation of any program or service carried out pursuant to section 
3001. The Secretary may provide such technical assistance directly or 
through grants to, or contracts with, public and private entities.
    ``(b) Provision of Supplies and Services in Lieu of Grant Funds.--
            ``(1) In general.--Upon the request of an eligible entity 
        receiving a grant under section 3001, the Secretary may, 
        subject to paragraph (2), provide supplies, equipment, and 
        services for the purpose of aiding the eligible entity in 
        carrying out such section and, for such purpose, may detail to 
        the eligible entity any officer or employee of the Department 
        of Health and Human Services.
            ``(2) Corresponding reduction in payments.--With respect to 
        a request described in paragraph (1), the Secretary shall 
        reduce the amount of payments under the grant under section 
        3001 to the eligible entity involved by an amount equal to the 
        costs of detailing personnel (including pay, allowances, and 
        travel expenses) and the fair market value of any supplies, 
        equipment, or services provided by the Secretary. The Secretary 
        shall, for the payment of expenses incurred in complying with 
        such request, expend the amounts withheld.

``SEC. 3008. EVALUATIONS AND REPORTS.

    ``(a) Evaluations.--The Secretary shall, directly or through 
contracts with public or private entities, provide for annual 
evaluations of programs carried out pursuant to section 3001.
    ``(b) Reports to Congress.--Not later than March 15, 2008, and 
every March 15 thereafter, the Secretary shall submit to the 
appropriate committees of Congress a report describing the grants 
awarded under this title, that includes--
            ``(1) a description of the screenings conducted, diagnoses 
        made, treatment received, and analysis of the impact of the 
        grants in terms of impact on mortality, morbidity, and economic 
        costs;
            ``(2) a description of those screening methods or 
        technologies for which the Secretary has made a determination 
        of grant eligibility; and
            ``(3) recommendations for administrative and legislative 
        initiatives with respect to this title as the Secretary 
        determines to be appropriate.
    ``(c) Congressional Approval.--The Secretary may not award a grant 
to an entity under this title to provide funding for a screening method 
or technology described in subsection (b)(2) if Congress, within 60 
days of receiving the report under such subsection, enacts a concurrent 
resolution to disapprove such funding.

``SEC. 3009. FUNDING.

    ``(a) Authorization of Appropriations.--For the purpose of carrying 
out this title, there are authorized to be appropriated such sums as 
may be necessary for fiscal year 2008 and each subsequent fiscal year.
    ``(b) Set-Aside for Technical Assistance and Provision of Supplies 
and Services.--Of the amounts appropriated under subsection (a) for a 
fiscal year, the Secretary shall reserve not more than 10 percent for 
carrying out section 3007.''.

SEC. 3. OPTIONAL MEDICAID COVERAGE OF CERTAIN CANCER PATIENTS.

    (a) Coverage as Optional Categorically Needy Groups.--
            (1) In general.--Section 1902(a)(10)(A)(ii) of the Social 
        Security Act (42 U.S.C. 1396a(a)(10)(A)(ii)) is amended--
                    (A) in subclause (XVIII), by striking ``or'' at the 
                end;
                    (B) in subclause (XIX), by adding ``or'' at the 
                end; and
                    (C) by adding at the end the following:
                                    ``(XX) who are described in 
                                subsection (dd) (relating to certain 
                                persons screened and found to need 
                                treatment from complications from 
                                screening or have certain cancers); or
                                    ``(XXI) who are described in 
                                subsection (ee) (relating to certain 
                                persons eligible for survivorship 
                                programs).''.
            (2) Groups described.--Section 1902 of such Act (42 U.S.C. 
        1396a) is amended by adding at the end the following:
    ``(dd) Individuals described in this subsection are individuals 
who--
            ``(1) are not described in subsection (a)(10)(A)(i);
            ``(2) have not attained age 65;
            ``(3) have been screened for cancer under the Centers for 
        Disease Control and Prevention cancer early detection program 
        established under title XXX of the Public Health Service Act 
        and have been referred under such program for treatment of 
        cancer; and
            ``(4) are not otherwise covered under creditable coverage, 
        as defined in section 2701(c) of the Public Health Services Act 
        (42 U.S.C. 300gg(c)).
    ``(ee) Individuals described in this subsection are individuals 
who--
            ``(1) are not described in subsection (a)(10)(A)(i);
            ``(2) have not attained age 65;
            ``(3) have been diagnosed with cancer, or have received 
        treatment for cancer, and are seeking medical information and 
        services related to the treatment of cancer (as determined by 
        the individual's treating physician) including--
                    ``(A) diagnosis and treatment for cancer, its 
                sequelae, and deleterious effects of treatment;
                    ``(B) a personalized comprehensive cancer treatment 
                and survivorship care plan; and
                    ``(C) an annual visit to an oncologist for a 
                comprehensive exam; and
            ``(4) are not otherwise covered under creditable coverage, 
        as defined in section 2701(c) of the Public Health Service Act 
        (42 U.S.C. 300gg(c)).''.
            (3) Limitation on benefits.--Section 1902(a)(10) of the 
        Social Security Act (42 U.S.C. 1396a(a)(10)) is amended in the 
        matter following subparagraph (G)
                    (A) by striking ``and (XIV)'' and inserting 
                ``(XIIV)''; and
                    (B) by inserting ``, and (XIV) the medical 
                assistance made available to an individual described in 
                subsection (dd) or (ee) who is eligible for medical 
                assistance only because of subclause (XX) or (XXI), 
                respectively, of subparagraph (A)(10)(ii) shall be 
                limited to medical assistance provided during the 
                period in which such an individual requires treatment 
                for the cancers or for medical assistance limited to 
                the services listed in subsections (dd) and (ee), 
                respectively'' before the semicolon.
            (4) Conforming amendments.--Section 1905(a) of the Social 
        Security Act (42 U.S.C. 1396d(a)) is amended in the matter 
        preceding paragraph (1)--
                    (A) in clause (xii), by striking ``or'' at the end;
                    (B) in clause (xiii), by adding ``or'' at the end; 
                and
                    (C) by inserting after clause (xiii) the following:
                            ``(xiv) individuals described in subsection 
                        (dd) or (ee) of section 1902,''.
    (b) Presumptive Eligibility.--
            (1) In general.--Title XIX of the Social Security Act is 
        amended by inserting after section 1920B (42 U.S.C. 1396r-1b) 
        the following:

   ``optional application of presumptive eligibility provisions for 
               certain persons with certain other cancers

    ``Sec. 1920C.  A State may elect to apply the provisions of section 
1920B to individuals described in subsection (dd) or (ee) of section 
1902 in the same as such section applies to individuals described in 
section 1902(aa) (relating to certain breast or cervical cancer 
patients).''.
            (2) Conforming amendments.--
                    (A) Section 1902(a)(47) of such Act (42 U.S.C. 
                1396a(a)(47)) is amended--
                            (i) by striking ``1920 and'' and inserting 
                        ``1920,'';
                            (ii) by striking ``with such section and'' 
                        and inserting ``with such section,''; and
                            (iii) by inserting before the semicolon at 
                        the end the following; ``, and provide for 
                        making medical assistance available to 
                        individuals described in 1920C during a 
                        presumptive eligibility period in accordance 
                        with such section''.
                    (B) Section 1903(u)(1)(D)(v) of such Act (42 
                U.S.C.1396b(u)(1)(D)(v)) is amended--
                            (i) by striking ``or for'' and inserting 
                        ``, for''; and
                            (ii) by inserting before the period the 
                        following: ``, or for medical assistance 
                        provided to an individual described in section 
                        1920C during a presumptive eligibility period 
                        under such section''.
    (c) Medicaid Match.--The first sentence of section 1905(b) of such 
Act (42 U.S.C. 1396d(b)) is amended--
            (1) by striking ``and'' before ``(4)''; and
            (2) by inserting before the period at the end the 
        following: ``, and (5) the Federal medical assistance 
        percentage shall be equal to the enhanced FMAP. described in 
        section 2105(b) with respect to medical assistance provided to 
        individuals who are eligible for such assistance only on the 
        basis of subclause (XX) of section 1902(a)(10)(A)(ii)''.
    (d) Effective Date.--The amendments made by this section apply to 
medical assistance for items and services furnished on or after October 
1, 2008, without regard to whether final regulations to carry out such 
amendments have been promulgated by such date.

SEC. 4. SCREENING RESEARCH AND SURVIVORSHIP PROGRAMS.

    Subpart 1 of part C of title IV of the Public Health Service Act 
(42 U.S.C. 285 et seq.) is amended by adding at the end the following:

``SEC. 417E. RESEARCH WITH RESPECT TO CANCER SCREENING.

    ``(a) Screening Research Initiatives.--
            ``(1) In general.--The Director of NIH shall expand, 
        intensify, and coordinate programs for the conduct and support 
        of research with respect to identifying and improving cancer 
        screening and testing protocols and tools in order to develop 
        screening and testing capable of achieving a recommendation of 
        `B' or better as measured by the Preventive Services Task Force 
        convened under section 915, and with particular emphasis on 
        those cancers with the highest incidence of mortality and 
        disability. The Director shall also consider new alternative 
        screening and testing protocols of lower cost and risk, and 
        those diagnostics which would identify cancers at a stage at 
        which there is strong evidence for the efficacy of treatment 
        which would reduce mortality and morbidity.
            ``(2) Administration.--The Director of NIH shall carry out 
        this subsection through the Director of the National Cancer 
        Institute and in collaboration with any other agencies that the 
        Director determines to be appropriate.
    ``(b) Public Awareness of Cancer Screening, Early Detection, 
Available Treatments and Research.--The Secretary shall award grants to 
recognized cancer professional and advocacy organizations, including 
private not-for-profit public affairs organizations, for the expansion 
and widespread implementation of activities to raise public awareness 
of currently available screening and testing programs, treatment 
options, statistics regarding improved outcomes as a result of cancer 
screenings, risk factors, information, treatment options, and current 
research with the intent to ensure widespread use of cancer screening 
programs and access to best available screening and testing services.

``SEC. 417F. CANCER SURVIVORSHIP.

    ``(a) NCI-Designated Cancer Centers.--The Director of NIH shall 
provide for the expansion and coordination of cancer survivorship 
research activities at National Cancer Institute-designated cancer 
centers.
    ``(b) Comprehensive Cancer Survivorship Centers.--
            ``(1) In general.--In carrying out the provisions of 
        subsection (a), the Director of NIH shall provide assistance to 
        one or more National Cancer Institute-designated cancer centers 
        to enable such centers to serve as comprehensive cancer 
        survivorship centers described in paragraph (2). Special 
        emphasis shall be placed on those models of comprehensive 
        cancer survivorship care that can be applied in community 
        cancer center settings, as well as National Cancer Institute-
        designated cancer centers.
            ``(2) Center description.--A comprehensive cancer 
        survivorship center described in this paragraph is a center 
        designed to serve as a comprehensive, one-stop source of 
        information, care, and services for cancer survivors, family 
        members, and service providers.
    ``(c) Evaluation of Models of Survivorship Care.--The Director of 
NIH shall provide assistance to one or more National Cancer Institute-
designated cancer centers for research to evaluate models of 
survivorship care.
    ``(d) Definition.--In this subsection, the term `Director of NIH' 
means the Director of NIH, acting through the Director of the National 
Cancer Institute.
    ``(e) Funding.--For the purpose of carrying out this section, there 
are authorized to be appropriated such sums as may be necessary for 
each of fiscal years 2008 through 2012.''.
                                 <all>
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