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Union Calendar No. 42 

110TH CONGRESS 

1ST SESSION H. R. 1132 

[Report No. 110–76] 

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 HOUSE OF REPRESENTATIVES 

FEBRUARY 16, 2007 

Ms. BALDWIN (for herself, Mrs. MYRICK, Mr. WAXMAN, Mrs. BLACKBURN, 

and Mrs. CAPPS) introduced the following bill; which was referred to the 

Committee on Energy and Commerce 

MARCH 27, 2007 

Additional sponsors: Mr. BERMAN, Mr. SHAYS, Mrs. CHRISTENSEN, Ms. 

DELAURO, Mr. MCDERMOTT, Ms. ESHOO, Ms. EDDIE BERNICE JOHNSON of Texas, Ms. MATSUI, Mr. BURTON of Indiana, Mr. HIGGINS, Mr. 

ALLEN, Mrs. NAPOLITANO, Ms. HERSETH, Mr. UDALL of New Mexico, 

Ms. CORRINE BROWN of Florida, Mr. TERRY, Mr. SAXTON, Ms. CARSON, 

Mr. GRIJALVA, Mrs. MALONEY of New York, Ms. MCCOLLUM of Minnesota, Mr. DELAHUNT, Ms. HOOLEY, Ms. BORDALLO, Ms. SCHWARTZ, 

Mr. KIND, Ms. LEE, Mr. BOUSTANY, Mr. PLATTS, Mr. COHEN, Ms. 

WOOLSEY, Mr. MCNULTY, Ms. BERKLEY, Mr. MCHUGH, Mr. CLEAVER, 

Mr. COURTNEY, Mr. MOORE of Kansas, Mr. RUSH, Mr. TIM MURPHY of 

Pennsylvania, Mr. ENGEL, Ms. SCHAKOWSKY, Mr. GENE GREEN of 

Texas, Mr. GORDON of Tennessee, Mr. UDALL of Colorado, Mr. KENNEDY, Mr. ELLISON, Mrs. DAVIS of California, Mr. MCINTYRE, Ms. 

SOLIS, Ms. SUTTON, Ms. HIRONO, Ms. ROS-LEHTINEN, Mr. KING of New 

York, Mr. OLVER, Mr. CAPUANO, Mr. GILLMOR, Mr. STARK, Mr. KAGEN, 

Ms. DEGETTE, Mr. TOWNS, Mr. CUMMINGS, Mr. GONZALEZ, and Ms. 

ZOE LOFGREN of California 

MARCH 27, 2007 

Reported with an amendment, committed to the Committee of the Whole 

House on the State of the Union, and ordered to be printed 

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[Strike out all after the enacting clause and insert the part printed in italic] 

[For text of introduced bill, see copy of bill as introduced on February 16, 2007] 

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’’. 

7 SEC. 2. NATIONAL BREAST AND CERVICAL CANCER EARLY 

8 DETECTION PROGRAM. 

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

10 300k et seq.) is amended— 

11 (1) in section 1501(d)— 

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

13 inserting ‘‘2020’’; and 

14 (B) by striking ‘‘by the year 2000’’ and in15 serting ‘‘by the year 2020’’; 

16 (2) in section 1503, by adding at the end the fol17 lowing: 

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1 ‘‘(d) WAIVER OF SERVICES REQUIREMENT ON DIVI2 SION OF FUNDS.— 

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

4 a demonstration project under which the Secretary 

5 may waive the requirements of paragraphs (1) and 

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

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

8 to leverage non-Federal funds to supplement each 

9 of the services or activities described in para10 graphs (1) and (2) of section 1501(a); 

11 ‘‘(B) the application of such requirement 

12 would result in a barrier to the enrollment of 

13 qualifying women; 

14 ‘‘(C) the State involved— 

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

16 the Secretary, the manner in which the 

17 State will use such waiver to expand the 

18 level of screening and follow-up services pro19 vided immediately prior to the date on 

20 which the waiver is granted; and 

21 ‘‘(ii) provides assurances, satisfactory 

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

23 annual basis, demonstrate, through such 

24 documentation as the Secretary may remstockstill on PROD1PC66 with BILLS

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1 quire, that the State has used such waiver 

2 as described in clause (i); 

3 ‘‘(D) the State involved submits to the Sec4 retary— 

5 ‘‘(i) assurances, satisfactory to the Sec6 retary, that the State will maintain the av7 erage annual level of State fiscal year ex8 penditures for the services and activities de9 scribed in paragraphs (1) and (2) of section 

10 1501(a) for the period for which the waiver 

11 is granted, and for the period for which any 

12 extension of such wavier is granted, at a 

13 level that is not less than— 

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

15 year expenditures for such services and 

16 activities for the fiscal year preceding 

17 the first fiscal year for which the waiv18 er is granted; or 

19 ‘‘(II) at the option of the State 

20 and upon approval by the Secretary, 

21 the average level of the State expendi22 tures for such services and activities 

23 for the 3-fiscal year period preceding 

24 the first fiscal year for which the waiv25 er is granted; and 

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1 ‘‘(ii) a plan, satisfactory to the Sec2 retary, for maintaining the level of activi3 ties carried out under the waiver after the 

4 expiration of the waiver and any extension 

5 of such waiver; 

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

7 a waiver to a State will increase the number of 

8 women in the State that receive each of the serv9 ices or activities described in paragraphs (1) and 

10 (2) of section 1501(a), including making avail11 able screening procedures for both breast and cer12 vical cancers; and 

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

14 a waiver to a State will not adversely affect the 

15 quality of each of the services or activities de16 scribed in paragraphs (1) and (2) of section 

17 1501(a). 

18 ‘‘(2) DURATION OF WAIVER.— 

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

20 under paragraph (1), the Secretary— 

21 ‘‘(i) shall grant such waivers for a pe22 riod that is not less than 1 year but not 

23 more than 2 years; and 

24 ‘‘(ii) upon request of a State, may ex25 tend a waiver for an additional period that 

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1 is not less than 1 year but not more than 

2 2 years in accordance with subparagraph 

3 (B). 

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

5 upon the request of a State that has received a 

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

7 the waiver period described in subparagraph 

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

9 may extend the waiver for an additional period 

10 if the Secretary determines that— 

11 ‘‘(i) without an extension of the waiv12 er, there will be a barrier to the enrollment 

13 of qualifying women; 

14 ‘‘(ii) the State requesting such extended 

15 waiver will use the waiver to leverage non16 Federal funds to supplement the services or 

17 activities described in paragraphs (1) and 

18 (2) of section 1501(a); 

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

20 will continue to increase, the number of 

21 women in the State that receive the services 

22 or activities described in paragraphs (1) 

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

24 ‘‘(iv) the waiver has not, and will not, 

25 result in lower quality in the State of the 

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1 services or activities described in para2 graphs (1) and (2) of section 1501(a); and 

3 ‘‘(v) the State has maintained the av4 erage annual level of State fiscal expendi5 tures for the services and activities described 

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

7 1501(a) for the period for which the waiver 

8 was granted at a level that is not less 

9 than— 

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

11 year expenditures for such services and 

12 activities for the fiscal year preceding 

13 the first fiscal year for which the waiv14 er is granted; or 

15 ‘‘(II) at the option of the State 

16 and upon approval by the Secretary, 

17 the average level of the State expendi18 tures for such services and activities 

19 for the 3-fiscal year period preceding 

20 the first fiscal year for which the waiv21 er is granted. 

22 ‘‘(3) REPORTING REQUIREMENTS.—The Sec23 retary shall include as part of the evaluations and re24 ports required under section 1508, the following: 

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

2 dollars leveraged annually from Non-Federal en3 tities in States receiving a waiver under para4 graph (1) and how these amounts were used. 

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

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

7 percentage of the grant that is expended on pro8 viding each of the services or activities described 

9 in— 

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

11 1501(a); and 

12 ‘‘(ii) paragraphs (3) through (6) of sec13 tion 1501(a). 

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

15 receiving waivers under paragraph (1) annually. 

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

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

18 ‘‘(i) the number of women receiving 

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

20 of section 1501(a) in programs before and 

21 after the granting of such waiver; and 

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

23 fiscal expenditures for the services and ac24 tivities described in paragraphs (1) and (2) 

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

2 first year for which the waiver was granted. 

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

4 applies under this subsection shall not be used to in5 crease the number of salaried employees. 

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

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

8 tribe’ has the meaning given the term in section 

9 4 of the Indian Health Care Improvement Act 

10 (25 U.S.C. 1603). 

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

12 ‘tribal organization’ has the meaning given the 

13 term in section 4 of the Indian Health Care Im14 provement Act. 

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

16 of the several States of the United States, the 

17 District of Columbia, the Commonwealth of 

18 Puerto Rico, American Samoa, the Common19 wealth of the Northern Mariana Islands, the Re20 public of the Marshall Islands, the Federated 

21 States of Micronesia, the Republic of Palau, an 

22 Indian tribe, and a tribal organization. 

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

24 waiver or extension under this subsection after Sep25 tember 30, 2012.’’; 

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1 (3) in section 1508— 

2 (A) in subsection (a), by striking ‘‘evalua3 tions of the extent to which’’ and all that follows 

4 through the period and inserting: ‘‘evaluations 

5 of— 

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

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

8 and with section 1504(c); and 

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

10 grant under this title is in compliance with section 

11 1502, including identification of— 

12 ‘‘(A) the amount of the non-Federal con13 tributions by the State for the preceding fiscal 

14 year, disaggregated according to the source of the 

15 contributions; and 

16 ‘‘(B) the proportion of such amount of non17 Federal contributions relative to the amount of 

18 Federal funds provided through the grant to the 

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

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

21 than 1 year after the date on which amounts are 

22 first appropriated pursuant to section 1509(a), 

23 and annually thereafter’’ and inserting ‘‘not 

24 later than 1 year after the date of the enactment 

25 of the National Breast and Cervical Cancer 

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1 Early Detection Program Reauthorization of 

2 2007, and annually thereafter’’; and 

3 (4) in section 1510(a)— 

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

5 for fiscal year 1994,’’; and 

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

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

8 $250,000,000 for fiscal year 2010, $255,000,000 

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

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

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Union Calendar No. 42 

110TH CONGRESS 

1ST SESSION H. R. 1132 

[Report No. 110

–76] 

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 27, 2007 

Reported with an amendment, committed to the Comand ordered to be printed mittee of the Whole House on the State of the Union, 

mstockstill on PROD1PC66 with BILLS