I 

110TH CONGRESS 

1ST SESSION H. R. 1738 

To amend the Public Health Service Act to establish a national screening 

program at the Centers for Disease Control and Prevention and to 

amend title XIX of the Social Security Act to provide States the option 

to provide medical assistance for men and women screened and found 

to have colorectal cancer or colorectal polyps. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 28, 2007 

Ms. GRANGER (for herself and Mr. WYNN) introduced the following bill; which 

was referred to the Committee on Energy and Commerce 

A BILL 

To amend the Public Health Service Act to establish a national screening program at the Centers for Disease Control and Prevention and to amend title XIX of the Social 

Security Act to provide States the option to provide 

medical assistance for men and women screened and 

found to have colorectal cancer or colorectal polyps. 

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 ‘‘Colorectal Cancer Pre5 vention, Early Detection, and Treatment Act of 2007’’. 

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1 SEC. 2. FINDINGS. 

2 Congress makes the following findings: 

3 (1) Colorectal cancer is the second leading 

4 cause of cancer deaths in the United States for men 

5 and women combined. 

6 (2) According to the American Cancer Society, 

7 in 2007, an estimated 153,760 new cases of 

8 colorectal cancer will be diagnosed in the United 

9 States and this cancer will kill an estimated 52,180 

10 individuals, constituting almost 10 percent of all 

11 cancer deaths. 

12 (3) Screening and early detection saves lives. 

13 When colorectal cancer is diagnosed at an early 

14 stage, the 5-year survival rate is 90 percent. 

15 (4) When colorectal cancer is not diagnosed 

16 until it has spread to distant organs, the 5-year sur17 vival rate drops to 10 percent. 

18 (5) Only 39 percent of colorectal cancer pa19 tients have their cancers detected at an early stage. 

20 (6) Despite the scientific evidence supporting 

21 the effectiveness of screening, there is only a 50 per22 cent screening rate of people in the United States 

23 who are 50 years of age and older. 

24 (7) Only 21 percent of those without health 

25 coverage in the United States have currently been 

26 screened for colorectal cancer. 

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1 (8) Far too many avoidable deaths are occur2 ring from a disease that can be prevented through 

3 the early identification and removal of pre-cancerous 

4 polyps, detectable only through colorectal cancer 

5 screenings. 

6 (9) The Centers for Disease Control and Pre7 vention is in its ninth year of the Screen for Life: 

8 National Colorectal Cancer Action Campaign, which 

9 informs men and women aged 50 years or older 

10 about the importance of having regular colorectal 

11 cancer screening tests. 

12 (10) If adults in the United States had received 

13 colorectal cancer screenings as recommended, at 

14 least 31,500 deaths would have been prevented and 

15 338,000 years of life would be gained this year. 

16 (11) Colorectal cancer screening has been 

17 shown to be more cost effective than screening for 

18 breast cancer and screening for cervical cancer, with 

19 the potential to save between 30,000 and 44,000 

20 lives a year if all individuals who are 50 years of age 

21 or older got screened for colorectal cancer. 

22 (12) Treatment costs for colorectal cancer are 

23 extremely high, and could be significantly reduced 

24 with widespread screening for colorectal cancer. 

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1 Costs associated with treatment for colorectal cancer 

2 are estimated at $8,400,000,000 for 2004. 

3 (13) Colorectal cancer screening is not only life 

4 saving, it is cost-effective. If recommended 

5 screenings were provided to an increased number of 

6 people in the United States who are between the 

7 ages of 50 years and 64 years of age, there would 

8 be a significant savings of billions of dollars to the 

9 Medicare program in screening and treatment costs. 

10 (14) In 2005, the Centers for Disease Control 

11 and Prevention established a demonstration 

12 colorectal cancer screening program at five sites 

13 across the United States to learn about the feasi14 bility of delivering screening and follow-up services 

15 to the population of low-income, uninsured, and 

16 underinsured individuals. The demonstration pro17 gram has already produced many findings that can 

18 inform a national effort to screen this population for 

19 colorectal cancer. 

20 SEC. 2. PREVENTIVE HEALTH MEASURES WITH RESPECT 

21 TO COLORECTAL CANCER. 

22 Part B of title III of the Public Health Service Act 

23 (42 U.S.C. 243 et seq.) is amended by inserting after sec24 tion 317S the following new section: 

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1 ‘‘SEC. 317T. PREVENTIVE HEALTH MEASURES WITH RE2 SPECT TO COLORECTAL CANCER. 

3 ‘‘(a) GRANT PROGRAM AUTHORIZATION.— 

4 ‘‘(1) IN GENERAL.—The Secretary, acting 

5 through the Director of the Centers for Disease 

6 Control and Prevention, may make grants to eligible 

7 entities for the purpose of carrying out a program 

8 described in subsection (b). An eligible entity that is 

9 a recipient of a grant under this subsection may use 

10 such grant to carry out such programs directly or 

11 through grants to, or contracts with, public and not12 for-profit private entities. 

13 ‘‘(2) ELIGIBLE ENTITY DEFINED.—For pur14 poses of this section, the term ‘eligible entity’ in15 cludes the following: 

16 ‘‘(A) A State, including, in addition to the 

17 several States, the District of Columbia, Guam, 

18 the Commonwealth of Puerto Rico, the North19 ern Mariana Islands, the Virgin Islands, Amer20 ican Samoa, and the Trust Territory of the Pa21 cific Islands. 

22 ‘‘(B) An Indian tribe or tribal organiza23 tion, as such terms are defined in section 4 of 

24 the Indian Self-Determination and Education 

25 Assistance Act. 

26 ‘‘(b) PROGRAMS DESCRIBED.— 

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1 ‘‘(1) IN GENERAL.—Subject to paragraph (2), a 

2 program described in this subsection is a program 

3 for planning or implementing the following: 

4 ‘‘(A) Providing screenings for colorectal 

5 cancer to individuals who— 

6 ‘‘(i) are 50 years of age or older; or 

7 ‘‘(ii)(I) are under 50 years of age; and 

8 ‘‘(II) are at high risk for such cancer. 

9 ‘‘(B) Providing appropriate case manage10 ment and referrals for medical treatment of in11 dividuals screened pursuant to subparagraph 

12 (A). 

13 ‘‘(C) Ensuring (directly or through coordi14 nation or an arrangement with health care pro15 viders or programs) the full continuum of fol16 lowup and cancer care for individuals so 

17 screened, including appropriate follow-up for 

18 abnormal tests, diagnostic services, therapeutic 

19 services, and treatment of detected cancers and 

20 management of unanticipated medical complica21 tions. 

22 ‘‘(D) Carrying out activities to improve the 

23 education, training, and skills of health profes24 sionals (including allied health professionals) in 

25 the detection and control of colorectal cancer, 

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1 which activities are carried out pursuant to the 

2 participation of the health professionals in the 

3 program. 

4 ‘‘(E) Establishing mechanisms through 

5 which the eligible entity involved can monitor 

6 the quality of screening and diagnostic follow7 up procedures for colorectal cancer, including 

8 the interpretation of such procedures. 

9 ‘‘(F) Evaluating the activities described in 

10 this subsection through appropriate surveillance 

11 and program monitoring activities. 

12 ‘‘(G) Developing and disseminating find13 ings derived through such evaluations and the 

14 collection of data on outcomes. 

15 ‘‘(H) Developing and disseminating public 

16 information and education programs for the de17 tection and control of colorectal cancer and pro18 moting the benefits of receiving screenings 

19 through this program. 

20 ‘‘(2) SUPPLEMENT NOT SUPPLANT.—In the 

21 case of an eligible entity that implements a universal 

22 colorectal screening program that funds activities de23 scribed in subparagraph (A), (B), or (C) of para24 graph (1), such entity shall be able to receive grant 

25 funds under subsection (a) only for purposes of— 

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1 ‘‘(A) carrying out those activities under 

2 this subsection that are not so funded; or 

3 ‘‘(B) supplementing (and not supplanting) 

4 funds made available by the entity for such 

5 funded program. 

6 ‘‘(c) PRIORITY FOR LOW-INCOME, UNINSURED AND

7 UNDERINSURED INDIVIDUALS.—A grant may be made 

8 under subsection (a) to an eligible entity only if the eligible 

9 entity agrees that, in providing screenings under sub10 section (b)(1)(A), the eligible entity will give priority to 

11 low-income individuals who lack adequate coverage under 

12 health insurance and health plans with respect to 

13 screenings for colorectal cancer. 

14 ‘‘(d) SPECIAL CONSIDERATION FOR CERTAIN APPLI15 CANTS.—In making grants under subsection (a) for a fis16 cal year, the Secretary shall give special consideration to 

17 the following eligible entities: 

18 ‘‘(1) In the case of services under such sub19 section for women, to such entities that, for such 

20 year, are grantees under title XV. 

21 ‘‘(2) In the case of services under such sub22 section for men, to such entities that, for such year, 

23 are grantees under section 317D. 

24 ‘‘(3) To such entities that coordinate with other 

25 Federal, State, and local colorectal cancer programs. 

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1 ‘‘(4) To such entities with an existing program 

2 to provide cancer screening to individuals. 

3 ‘‘(e) USE OF CERTAIN STANDARDS UNDER MEDI4 CARE PROGRAM.—A grant may be made under subsection 

5 (a) to an eligible entity only if the eligible entity provides, 

6 as applicable, assurances as follows: 

7 ‘‘(1) Screenings under subsection (b)(1)(A) will 

8 be carried out as preventive health measures in ac9 cordance with evidence-based screening guidelines 

10 and procedures as specified in section 1861(pp)(1) 

11 of the Social Security Act. 

12 ‘‘(2) An individual will be considered high risk 

13 for purposes of subsection (b)(1)(A)(ii) only if the 

14 individual is high risk within the meaning of section 

15 1861(pp)(2) of such Act. 

16 ‘‘(3) The payment made from the grant for a 

17 screening procedure under subsection (b)(1)(A) will 

18 not exceed the amount that would be paid under 

19 part B of title XVIII of such Act if payment were 

20 made under such part for furnishing the procedure 

21 to an individual enrolled under such part. 

22 ‘‘(f) RELATIONSHIP TO ITEMS AND SERVICES UNDER

23 OTHER PROGRAMS.—A grant under subsection (a) may 

24 be made to an eligible entity only if the eligible entity, 

25 as applicable, provides assurances that the grant will not 

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1 be expended to make payment for any item or service to 

2 the extent that payment has been made, or can reasonably 

3 be expected to be made, with respect to such item or serv4 ice— 

5 ‘‘(1) under any State compensation program, 

6 under an insurance policy, or under any Federal or 

7 State health benefits program; or 

8 ‘‘(2) by an entity that provides health services 

9 on a prepaid basis. 

10 ‘‘(g) RECORDS AND AUDITS.—A grant under sub11 section (a) may be made to an eligible entity only if the 

12 eligible entity provides assurances that the eligible entity 

13 will— 

14 ‘‘(1) establish such fiscal control and fund ac15 counting procedures as may be necessary to ensure 

16 proper disbursal of, and accounting for, amounts re17 ceived under subsection (a); and 

18 ‘‘(2) upon request, provide records maintained 

19 pursuant to paragraph (1) to the Secretary or the 

20 Comptroller General of the United States for pur21 poses of auditing the expenditures of the grant by 

22 the eligible entity. 

23 ‘‘(h) REQUIREMENT OF MATCHING FUNDS.— 

24 ‘‘(1) IN GENERAL.—The Secretary may not 

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1 tity for a fiscal year unless the eligible entity agrees, 

2 with respect to the costs to be incurred by the eligi3 ble entity for such fiscal year in carrying out the ac4 tivities described in subsection (b), to make available 

5 non-Federal contributions (in cash or in kind under 

6 paragraph (2)) toward such costs in an amount 

7 equal to not less than $1 for each $3 of Federal 

8 funds provided in the grant for such fiscal year. 

9 Such contributions may be made directly or through 

10 donations from public or private entities. 

11 ‘‘(2) DETERMINATION OF AMOUNT OF NON12 FEDERAL CONTRIBUTION.— 

13 ‘‘(A) IN GENERAL.—Non-Federal contribu14 tions required in paragraph (1) may be in cash 

15 or in kind, fairly evaluated, including equipment 

16 or services (and excluding indirect or overhead 

17 costs). Amounts provided by the Federal Gov18 ernment, or services assisted or subsidized to 

19 any significant extent by the Federal Govern20 ment, may not be included in determining the 

21 amount of such non-Federal contributions. 

22 ‘‘(B) MAINTENANCE OF EFFORT.—In 

23 making a determination of the amount of non24 Federal contributions for purposes of paragraph 

25 (1), the Secretary may include only non-Federal 

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1 contributions in excess of the average amount 

2 of non-Federal contributions made by the eligi3 ble entity involved toward the activities de4 scribed in subsection (b) for the 2-year period 

5 preceding the first fiscal year for which the eli6 gible entity is applying to receive a grant under 

7 subsection (a). 

8 ‘‘(C) INCLUSION OF RELEVANT NON-FED9 ERAL CONTRIBUTIONS FOR MEDICAID.—In 

10 making a determination of the amount of non11 Federal contributions for purposes of paragraph 

12 (1), the Secretary shall, subject to subpara13 graphs (A) and (B) of this paragraph, include 

14 any non-Federal amounts expended pursuant to 

15 title XIX of the Social Security Act by the eligi16 ble entity involved toward the activities de17 scribed in subparagraphs (A) and (B) of sub18 section (b)(1). 

19 ‘‘(i) ADDITIONAL REQUIREMENTS.— 

20 ‘‘(1) LIMITATION ON ADMINISTRATIVE EX21 PENSES.—The Secretary may not make a grant to 

22 an eligible entity under subsection (a) unless the eli23 gible entity provides assurances that not more than 

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1 istrative expenses with respect to the activities fund2 ed by the grant. 

3 ‘‘(2) STATEWIDE PROVISION OF SERVICES.— 

4 ‘‘(A) IN GENERAL.—Subject to subpara5 graph (B), the Secretary may not make a grant 

6 under subsection (a) to an eligible entity unless 

7 the eligible entity provides assurances that any 

8 program funded by such grant will be made 

9 available throughout the State, including avail10 ability to members of an Indian tribe or tribal 

11 organization (as such terms are defined in sec12 tion 4 of the Indian Self-Determination and 

13 Education Assistance Act). 

14 ‘‘(B) WAIVER.—The Secretary may waive 

15 the requirement under subparagraph (A) for an 

16 eligible entity if the Secretary determines that 

17 compliance by the eligible entity with the re18 quirement would result in an inefficient alloca19 tion of resources with respect to carrying out 

20 the purposes described in subsection (a). 

21 ‘‘(j) TECHNICAL ASSISTANCE AND PROVISION OF

22 SUPPLIES AND SERVICES IN LIEU OF GRANT FUNDS.— 

23 ‘‘(1) TECHNICAL ASSISTANCE.—The Secretary 

24 may provide training and technical assistance with 

25 respect to the planning, development, and operation 

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1 of any program funded by a grant under subsection 

2 (a). The Secretary may provide such technical as3 sistance directly to eligible entities or through grants 

4 to, or contracts with, public and private entities. 

5 ‘‘(2) PROVISION OF SUPPLIES AND SERVICES IN

6 LIEU OF GRANT FUNDS.— 

7 ‘‘(A) IN GENERAL.—Subject to subpara8 graph (B), upon the request of an eligible entity 

9 receiving a grant under subsection (a), the Sec10 retary for the purpose of aiding the eligible en11 tity to carry out a program under subsection 

12 (b)— 

13 ‘‘(i) may provide supplies, equipment, 

14 and services to the eligible entity; and 

15 ‘‘(ii) may detail to the eligible entity 

16 any officer or employee of the Department 

17 of Health and Human Services. 

18 ‘‘(B) CORRESPONDING REDUCTION IN PAY19 MENTS.—With respect to a request made by an 

20 eligible entity under subparagraph (A), the Sec21 retary shall reduce the amount of payments 

22 made under the grant under subsection (a) to 

23 the eligible entity by an amount equal to the 

24 fair market value of any supplies, equipment, or 

25 services provided by the Secretary and the costs 

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1 of detailing personnel (including pay, allow2 ances, and travel expenses) under subparagraph 

3 (A). The Secretary shall, for the payment of ex4 penses incurred in complying with such request, 

5 expend the amounts withheld. 

6 ‘‘(k) REPORTS.—A grant under subsection (a) may 

7 be made only if the applicant involved agrees to submit 

8 to the Secretary such reports as the Secretary may require 

9 with respect to the grant. 

10 ‘‘(l) AUTHORIZATION OF APPROPRIATIONS.— 

11 ‘‘(1) IN GENERAL.—For the purpose of car12 rying out this section, there are authorized to be ap13 propriated $50,000,000 for fiscal year 2008, and 

14 such sums as may be necessary for each of the fiscal 

15 years 2009 through 2012. 

16 ‘‘(2) SET-ASIDE FOR TECHNICAL ASSISTANCE

17 AND PROVISION OF SUPPLIES AND SERVICES.—Of 

18 the amount appropriated under paragraph (1) for a 

19 fiscal year, the Secretary shall reserve not to exceed 

20 20 percent for carrying out subsection (j).’’. 

21 SEC. 3. OPTIONAL MEDICAID COVERAGE OF CERTAIN PER22 SONS SCREENED AND FOUND TO HAVE 

23 COLORECTAL CANCER. 

24 (a) COVERAGE AS OPTIONAL CATEGORICALLY

25 NEEDY GROUP.— 

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1 (1) IN GENERAL.—Section 1902(a)(10)(A)(ii) 

2 of the Social Security Act (42 U.S.C. 

3 1396a(a)(10)(A)(ii)) is amended— 

4 (A) in subclause (XVIII), by striking ‘‘or’’ 

5 at the end; 

6 (B) in subclause (XIX), by adding ‘‘or’’ at 

7 the end; and 

8 (C) by adding at the end the following: 

9 ‘‘(XX) who are described in sub10 section (dd) (relating to certain per11 sons screened and found to need 

12 treatment from complications from 

13 screening or have colorectal cancer);’’. 

14 (2) GROUP DESCRIBED.—Section 1902 of the 

15 Social Security Act (42 U.S.C. 1396a) is amended 

16 by adding at the end the following: 

17 ‘‘(dd) Individuals described in this subsection are in18 dividuals who— 

19 ‘‘(1) are not described in subsection 

20 (a)(10)(A)(i); 

21 ‘‘(2) have not attained age 65; 

22 ‘‘(3) have been screened for colorectal cancer 

23 and need treatment for complications due to screen24 ing or colorectal cancer; and 

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1 ‘‘(4) are not otherwise covered under creditable 

2 coverage, as defined in section 2701(c) of the Public 

3 Health Service Act.’’. 

4 (3) LIMITATION ON BENEFITS.—Section 

5 1902(a)(10) of the Social Security Act (42 U.S.C. 

6 1396a(a)(10)) is amended in the matter following 

7 subparagraph (G)— 

8 (A) by striking ‘‘and (XIV)’’ and inserting 

9 ‘‘(XIV)’’; and 

10 (B) by inserting ‘‘, and (XV) the medical 

11 assistance made available to an individual de12 scribed in subsection (dd) who is eligible for 

13 medical assistance only because of subpara14 graph (A)(10)(ii)(XX) shall be limited to med15 ical assistance provided during the period in 

16 which such an individual requires treatment for 

17 complications due to screening or colorectal 

18 cancer’’ before the semicolon. 

19 (4) CONFORMING AMENDMENTS.—Section 

20 1905(a) of the Social Security Act (42 U.S.C. 

21 1396d(a)) is amended in the matter preceding para22 graph (1)— 

23 (A) in clause (xii), by striking ‘‘or’’ at the 

24 end; 

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1 (B) in clause (xiii), by adding ‘‘or’’ at the 

2 end; and 

3 (C) by inserting after clause (xiii) the fol4 lowing: 

5 ‘‘(xiv) individuals described in section 

6 1902(dd),’’. 

7 (b) PRESUMPTIVE ELIGIBILITY.— 

8 (1) IN GENERAL.—Title XIX of the Social Se9 curity Act (42 U.S.C. 1396 et seq.) is amended by 

10 inserting after section 1920B the following: 

11 ‘‘OPTIONAL APPLICATION OF PRESUMPTIVE ELIGIBILITY

12 PROVISIONS FOR CERTAIN PERSONS WITH

13 COLORECTAL CANCER

14 ‘‘SEC. 1920C. A State may elect to apply the provi15 sions of section 1920B to individuals described in section 

16 1902(dd) (relating to certain colorectal cancer patients) 

17 in the same manner as such section applies to individuals 

18 described in section 1902(aa) (relating to certain breast 

19 or cervical cancer patients).’’. 

20 (2) CONFORMING AMENDMENTS.— 

21 (A) Section 1902(a)(47) of the Social Se22 curity Act (42 U.S.C. 1396a(a)(47)) is amend23 ed— 

24 (i) by striking ‘‘and’’ after ‘‘section 

25 1920’’ and inserting a comma; 

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1 (ii) by striking ‘‘and’’ after ‘‘with such 

2 section’’ and inserting a comma; and 

3 (iii) by inserting before the semicolon 

4 at the end the following: ‘‘, and provide for 

5 making medical assistance available to in6 dividuals described in section 1920C dur7 ing a presumptive eligibility period in ac8 cordance with such section’’. 

9 (B) Section 1903(u)(1)(d)(v) of such Act 

10 (42 U.S.C. 1396b(u)(1)(d)(v)) is amended— 

11 (i) by striking ‘‘or for’’ and inserting 

12 ‘‘, for’’; and 

13 (ii) by inserting before the period the 

14 following: ‘‘, or for medical assistance pro15 vided to an individual described in section 

16 1920C during a presumptive eligibility pe17 riod under such section’’. 

18 (e) ENHANCED MATCH.—The first sentence of sec19 tion 1905(b) of the Social Security Act (42 U.S.C. 

20 1396d(b)) is amended— 

21 (1) by striking ‘‘and’’ before ‘‘(4)’’; and 

22 (2) by inserting before the period at the end the 

23 following: ‘‘, and (5) the Federal medical assistance 

24 percentage shall be equal to the enhanced FMAP de25 scribed in section 2105(b) with respect to medical 

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1 assistance provided to individuals who are eligible 

2 for such assistance only on the basis of section 

3 1902(a)(10)(A)(ii)(XX)’’. 

4 (f) EFFECTIVE DATE.—The amendments made by 

5 this section apply to medical assistance for items and serv6 ices furnished on or after October 1, 2007, without regard 

7 to whether final regulations to carry out such amendments 

8 have been promulgated by such date. 

Æ 

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