110TH CONGRESS 

1ST SESSION H. R. 1132

AN ACT

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 may waive the requirements of paragraphs 

21 (1) and (4) of subsection (a) for not more than 5 

22 States, if—

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

24 to leverage non-Federal funds to supplement 

25 each of the services or activities described in 

26 paragraphs (1) and (2) of section 1501(a); 
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1 ‘‘(B) the application of such requirement 

2 would result in a barrier to the enrollment of 

3 qualifying women; 

4 ‘‘(C) the State involved—

5 ‘‘(i) demonstrates, to the satisfaction 

6 of the Secretary, the manner in which the 

7 State will use such waiver to expand the 

8 level of screening and follow-up services 

9 provided immediately prior to the date on 

10 which the waiver is granted; and 

11 ‘‘(ii) provides assurances, satisfactory 

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

13 annual basis, demonstrate, through such 

14 documentation as the Secretary may re15 quire, that the State has used such waiver 

16 as described in clause (i); 

17 ‘‘(D) the State involved submits to the 

18 Secretary—

19 ‘‘(i) assurances, satisfactory to the 

20 Secretary, that the State will maintain the 

21 average annual level of State fiscal year ex22 penditures for the services and activities 

23 described in paragraphs (1) and (2) of sec24 tion 1501(a) for the period for which the 

25 waiver is granted, and for the period for 
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1 which any extension of such wavier is 

2 granted, at a level that is not less than—

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

4 year expenditures for such services 

5 and activities for the fiscal year pre6 ceding the first fiscal year for which 

7 the waiver is granted; or 

8 ‘‘(II) at the option of the State 

9 and upon approval by the Secretary, 

10 the average level of the State expendi11 tures for such services and activities 

12 for the 3-fiscal year period preceding 

13 the first fiscal year for which the 

14 waiver is granted; and 

15 ‘‘(ii) a plan, satisfactory to the Sec16 retary, for maintaining the level of activi17 ties carried out under the waiver after the 

18 expiration of the waiver and any extension 

19 of such waiver; 

20 ‘‘(E) the Secretary finds that granting 

21 such a waiver to a State will increase the num22 ber of women in the State that receive each of 

23 the services or activities described in para24 graphs (1) and (2) of section 1501(a), including 
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1 making available screening procedures for both 

2 breast and cervical cancers; and 

3 ‘‘(F) the Secretary finds that granting 

4 such a waiver to a State will not adversely af5 fect the quality of each of the services or activi6 ties described in paragraphs (1) and (2) of sec7 tion 1501(a). 

8 ‘‘(2) DURATION OF WAIVER.—

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

10 under paragraph (1), the Secretary—

11 ‘‘(i) shall grant such waivers for a pe12 riod that is not less than 1 year but not 

13 more than 2 years; and 

14 ‘‘(ii) upon request of a State, may ex15 tend a waiver for an additional period that 

16 is not less than 1 year but not more than 

17 2 years in accordance with subparagraph 

18 (B). 

19 ‘‘(B) ADDITIONAL PERIOD.—The Sec20 retary, upon the request of a State that has re21 ceived a waiver under paragraph (1), shall, at 

22 the end of the waiver period described in sub23 paragraph (A)(i), review performance under the 

24 waiver and may extend the waiver for an addi25 tional period if the Secretary determines that—
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1 ‘‘(i) without an extension of the waiv2 er, there will be a barrier to the enrollment 

3 of qualifying women; 

4 ‘‘(ii) the State requesting such ex5 tended waiver will use the waiver to lever6 age non-Federal funds to supplement the 

7 services or activities described in para8 graphs (1) and (2) of section 1501(a); 

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

10 will continue to increase, the number of 

11 women in the State that receive the serv12 ices or activities described in paragraphs 

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

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

15 result in lower quality in the State of the 

16 services or activities described in para17 graphs (1) and (2) of section 1501(a); and 

18 ‘‘(v) the State has maintained the av19 erage annual level of State fiscal expendi20 tures for the services and activities de21 scribed in paragraphs (1) and (2) of sec22 tion 1501(a) for the period for which the 

23 waiver was granted at a level that is not 

24 less than—
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1 ‘‘(I) the level of the State fiscal 

2 year expenditures for such services 

3 and activities for the fiscal year pre4 ceding the first fiscal year for which 

5 the waiver is granted; or 

6 ‘‘(II) at the option of the State 

7 and upon approval by the Secretary, 

8 the average level of the State expendi9 tures for such services and activities 

10 for the 3-fiscal year period preceding 

11 the first fiscal year for which the 

12 waiver is granted. 

13 ‘‘(3) REPORTING REQUIREMENTS.—The Sec14 retary shall include as part of the evaluations and 

15 reports required under section 1508, the following: 

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

17 dollars leveraged annually from Non-Federal 

18 entities in States receiving a waiver under para19 graph (1) and how these amounts were used. 

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

21 waiver under paragraph (1), a description of 

22 the percentage of the grant that is expended on 

23 providing each of the services or activities de24 scribed in—
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1 ‘‘(i) paragraphs (1) and (2) of section 

2 1501(a); and 

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

4 section 1501(a). 

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

6 receiving waivers under paragraph (1) annually. 

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

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

9 ‘‘(i) the number of women receiving 

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

11 of section 1501(a) in programs before and 

12 after the granting of such waiver; and 

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

14 fiscal expenditures for the services and ac15 tivities described in paragraphs (1) and (2) 

16 of section 1501(a) for the year preceding 

17 the first year for which the waiver was 

18 granted. 

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

20 applies under this subsection shall not be used to in21 crease the number of salaried employees. 

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

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

24 tribe’ has the meaning given the term in section 
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1 4 of the Indian Health Care Improvement Act 

2 (25 U.S.C. 1603). 

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

4 ‘tribal organization’ has the meaning given the 

5 term in section 4 of the Indian Health Care Im6 provement Act. 

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

8 each of the several States of the United States, 

9 the District of Columbia, the Commonwealth of 

10 Puerto Rico, American Samoa, the Common11 wealth of the Northern Mariana Islands, the 

12 Republic of the Marshall Islands, the Federated 

13 States of Micronesia, the Republic of Palau, an 

14 Indian tribe, and a tribal organization. 

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

16 waiver or extension under this subsection after Sep17 tember 30, 2012.’’; 

18 (3) in section 1508—

19 (A) in subsection (a), by striking ‘‘evalua20 tions of the extent to which’’ and all that fol21 lows through the period and inserting: ‘‘evalua22 tions of—

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

24 such programs are in compliance with section 

25 1501(a)(2) and with section 1504(c); and 
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1 ‘‘(2) the extent to which each State receiving a 

2 grant under this title is in compliance with section 

3 1502, including identification of—

4 ‘‘(A) the amount of the non-Federal con5 tributions by the State for the preceding fiscal 

6 year, disaggregated according to the source of 

7 the contributions; and 

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

9 non-Federal contributions relative to the 

10 amount of Federal funds provided through the 

11 grant to the State for the preceding fiscal 

12 year.’’; and 

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

14 later than 1 year after the date on which 

15 amounts are first appropriated pursuant to sec16 tion 1509(a), and annually thereafter’’ and in17 serting ‘‘not later than 1 year after the date of 

18 the enactment of the National Breast and Cer19 vical Cancer Early Detection Program Reau20 thorization of 2007, and annually thereafter’’; 

21 and 

22 (4) in section 1510(a)—

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

24 for fiscal year 1994,’’; and 
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1 (B) by inserting ‘‘, $225,000,000 for fiscal 

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

3 $250,000,000 for fiscal year 2010, 

4 $255,000,000 for fiscal year 2011, and 

5 $275,000,000 for fiscal year 2012’’ before the 

6 period at the end. 

Passed the House of Representatives March 27, 

2007. 

Attest:

Clerk. 
110TH CONGRESS 

1ST SESSION H. R. 1132

AN ACT

To amend the Public Health Service Act to provide 

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