II 

108TH CONGRESS 

2D SESSION S. 2771

To amend the Public Health Service Act to improve the quality of care 

for cancer, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

JULY 22, 2004

Mr. FRIST (for himself and Mr. KENNEDY) introduced the following bill; 

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

A BILL

To amend the Public Health Service Act to improve the 

quality of care for cancer, and for other purposes.

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 ‘‘Quality of Care for 

5 Individuals With Cancer Act’’. 

6 SEC. 2. TABLE OF CONTENTS.

Sec. 1. Short title. 

Sec. 2. Table of contents. 

TITLE I—MEASURING THE QUALITY OF CANCER CARE 

Sec. 101. Development of core sets of quality of cancer care measures. 

TITLE II—ENHANCING DATA COLLECTION 
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Sec. 201. Expansion of national program of cancer registries. 

Sec. 202. Reauthorization of national program of cancer registries. 

Sec. 203. Relationship to certification. 

TITLE III—MONITORING AND EVALUATING QUALITY OF CANCER 

CARE AND OUTCOMES 

Sec. 301. Partnerships to develop model systems for monitoring and evaluating 

quality of cancer care and outcomes. 

TITLE IV—STRENGTHENING COMPREHENSIVE CANCER CONTROL 

Sec. 401. Comprehensive cancer control program. 

TITLE V—IMPROVING NAVIGATION AND SYSTEM COORDINATION 

Sec. 501. Enhancing cancer care through improved navigation. 

Sec. 502. Cancer care coordination. 

TITLE VI—ESTABLISHING PROGRAMS IN PALLIATIVE CARE 

Sec. 601. Programs to improve palliative care. 

TITLE VII—ESTABLISHING SURVIVORSHIP PROGRAMS 

Sec. 701. Programs for survivorship. 

Sec. 702. Cancer control programs. 

TITLE VIII—PROGRAMS FOR END-OF-LIFE CARE 

Sec. 801. Programs for end-of-life care. 

TITLE IX—DEVELOPING TRAINING CURRICULA 

Sec. 901. Curriculum development. 

Sec. 902. Cancer care workforce and translational research. 

TITLE X—BREAST AND CERVICAL CANCER 

Sec. 1001. Waivers relating to grants for preventive health measures with respect to breast and cervical cancers. 

TITLE XI—COLORECTAL CANCER 

Sec. 1101. Programs to improve colorectal cancer screening. 

TITLE XII—CONDUCTING REPORTS 

Sec. 1201. Studies and reports by the Institute of Medicine.
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1 TITLE I—MEASURING THE 

2 QUALITY OF CANCER CARE 

3 SEC. 101. DEVELOPMENT OF CORE SETS OF QUALITY OF 

4 CANCER CARE MEASURES. 

5 (a) DEVELOPMENT OF CORE SETS OF QUALITY OF

6 CANCER CARE MEASURES.—Subpart 1 of part C of title 

7 IV of the Public Health Service Act (42 U.S.C. 285 et 

8 seq.) is amended by adding at the end the following: 

9 ‘‘SEC. 417E. DEVELOPMENT OF CORE SETS OF QUALITY OF 

10 CANCER CARE MEASURES. 

11 ‘‘(a) IN GENERAL.—The Secretary shall award a con12 tract to a national voluntary consensus organization to 

13 identify core sets of quality of cancer care measures. 

14 ‘‘(b) QUALITY OF CANCER CARE MEASURES.—An 

15 entity that receives a contract under this section shall 

16 identify core sets of quality of cancer care measures in 

17 consultation with a panel or advisory group of interested 

18 parties, including significant participation from consumer 

19 representatives (which shall include survivors of cancer 

20 and their families and members of organizations rep21 resenting such survivors and their families), health care 

22 providers, cancer researchers, payers and purchasers of 

23 cancer care services and insurance, and public and private 

24 organizations that monitor, accredit, or seek to improve 

25 the quality of cancer care. 
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1 ‘‘(c) REPORT BY ENTITY.—Not later than 24 months 

2 after the date of enactment of this section, an eligible enti3 ty that receives a contract under this section shall submit 

4 to the Secretary a report that—

5 ‘‘(1) lists existing measures used to assess and 

6 improve the quality of cancer care; 

7 ‘‘(2) identifies those measures that have been 

8 scientifically validated, those measures that still re9 quire validation, and those aspects of cancer care for 

10 which additional measures need to be developed or 

11 validated; 

12 ‘‘(3) recommends a core set of validated quality 

13 of cancer care measures, reflecting a voluntary con14 sensus of interested parties, for measuring and im15 proving the quality of cancer care; 

16 ‘‘(4) summarizes the process used to develop 

17 the consensus recommendations in paragraph (3), 

18 including a statement of any minority views; and 

19 ‘‘(5) develops a process for updating the core 

20 sets of validated quality of cancer care measures as 

21 new scientific evidence becomes available. 

22 ‘‘(d) RECOMMENDATIONS BY SECRETARY.—Not later 

23 than 6 months after the date the Secretary receives the 

24 report described in subsection (c), the Secretary shall issue 

25 recommendations on the areas described in paragraphs (1) 
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1 through (5) of such subsection and shall transmit such 

2 recommendations to the President. 

3 ‘‘(e) REPORT BY PRESIDENT.—Not later than 6 

4 months after receipt of the report described in subsection 

5 (d), the President shall, in consultation with the Quality 

6 Interagency Coordination Task Force (established by a 

7 Presidential Directive in 1998)—

8 ‘‘(1) provide to the appropriate committees of 

9 Congress a report that describes a plan to use the 

10 core sets of quality of cancer care measures in pro11 grams administered by the Federal Government, in12 cluding outlining activities to support the widespread 

13 dissemination of the report, and provide any other 

14 recommendations the President determines to be ap15 propriate; and 

16 ‘‘(2) provide updated reports, in accordance 

17 with subsection (c)(5), if new quality measures or 

18 scientific evidence on quality of cancer care develops. 

19 ‘‘(f) TECHNICAL SUPPORT.—The Secretary may pro20 vide scientific and technical support to ensure that the sci21 entific evaluation requirements in this section are met. 

22 ‘‘(g) AHRQ.—

23 ‘‘(1) ANNUAL REPORT.—The Agency for 

24 Healthcare Research and Quality shall include in the 

25 annual report required under section 913(b)(2) the
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•S 2771 IS 

1 core set of quality of cancer care measures developed 

2 under this section that are suitable for quality moni3 toring. 

4 ‘‘(2) REQUIREMENT.—The Secretary shall en5 sure that all agencies within the Department of 

6 Health and Human Services shall provide the infor7 mation necessary for the report described in para8 graph (1) regarding quality of cancer care measures.

9 ‘‘(h) SUPPORT.—The Director of the Agency for 

10 Healthcare Research and Quality, acting in collaboration 

11 with the Director of the National Cancer Institute and the 

12 Director of the Centers for Disease Control and Preven13 tion, shall support the development and validation of 

14 measures identified by the report in subsection (d). 

15 ‘‘(i) DEFINITIONS OF HOSPICE CARE; PALLIATIVE

16 CARE; QUALITY OF CANCER CARE; HEALTH DISPARITY

17 POPULATIONS; HEALTH DISPARITIES RESEARCH.—In 

18 this section the terms ‘hospice care’, ‘palliative care’, 

19 ‘quality of cancer care’, ‘health disparity populations’, and 

20 ‘minority health disparities research’ have the meanings 

21 given such terms in section 399AA. 

22 ‘‘(j) AUTHORIZATION OF APPROPRIATIONS.—There 

23 is authorized to be appropriated to carry out this section, 

24 such sums as may be necessary for each of fiscal years 

25 2006 through 2010.’’. 
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1 (b) MONITORING.—Not later than 4 years after the 

2 date of the transmission of the report required under sec3 tion 417E(e) of the Public Health Service Act, the Comp4 troller of the General Accounting Office shall submit to 

5 the appropriate committees of Congress a report that eval6 uates the extent to which Federal and private sector 

7 health care delivery programs, States, and State cancer 

8 plans are utilizing the core sets of quality of cancer care 

9 measures (developed under section 417E of the Public 

10 Health Service Act) and the extent to which its adoption 

11 is affecting the quality of cancer care. 

12 TITLE II—ENHANCING DATA 

13 COLLECTION 

14 SEC. 201. EXPANSION OF NATIONAL PROGRAM OF CANCER 

15 REGISTRIES. 

16 Part M of title III of the Public Health Service Act 

17 (42 U.S.C. 280e et seq.) is amended by inserting after 

18 section 399E, the following: 

19 ‘‘SEC. 399E–1. MONITORING AND EVALUATING THE QUALITY 

20 OF CANCER CARE. 

21 ‘‘(a) DEMONSTRATION PROJECTS.—The Secretary, 

22 acting through the Director of the Centers for Disease 

23 Control and Prevention, and in coordination with the Di24 rector of the National Cancer Institute, shall award com25 petitive grants to State cancer registries that receive funds 
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•S 2771 IS 

1 under this part to enable such registries to expand their 

2 ability to monitor and evaluate the quality of cancer care, 

3 to develop information concerning the quality of cancer 

4 care, and to monitor cancer survivorship. 

5 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 

6 under subsection (a), a State cancer registry shall be cer7 tified by the North American Association of Central Can8 cer Registries or other similar certification organization. 

9 ‘‘(c) APPLICATION.—A State cancer registry desiring 

10 a grant under this section shall submit an application to 

11 the Secretary at such time, in such manner, and con12 taining such information as the Secretary may require. 

13 ‘‘(d) CONTRACTING AUTHORITY.—A State cancer 

14 registry receiving a grant under this section may enter 

15 into contracts with academic institutions, cancer centers, 

16 and other entities determined to be appropriate by the 

17 Secretary, to carry out the activities authorized under this 

18 section. 

19 ‘‘(e) USE OF FUNDS.—A State cancer registry receiv20 ing a grant under this section shall use amounts received 

21 under such grant to—

22 ‘‘(1) collect information for public health sur23 veillance and quality improvement activities using 

24 the quality of cancer care measures developed under 

25 section 417E (where appropriate), including data 
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1 concerning racial, ethnic, and other health disparity 

2 populations within the State that may have a dis3 parity in incidence or survival from cancer; 

4 ‘‘(2) develop linkages between State cancer reg5 istry data and other databases, including those that 

6 collect outpatient data, to gather information con7 cerning the quality of cancer care; 

8 ‘‘(3) identify, develop, and disseminate evi9 dence-based best practices relating to cancer care re10 garding how States use registry data and how to 

11 better link and coordinate the sharing of such data; 

12 ‘‘(4) identify geographic areas and populations 

13 within the State that have an increased need for 

14 awareness regarding cancer risk reduction, screen15 ing, prevention, and treatment activities; 

16 ‘‘(5) increase coordination between State cancer 

17 registries and other entities, including academic in18 stitutions, hospitals, health centers, researchers, 

19 health care providers, cancer centers, or nonprofit 

20 organizations; 

21 ‘‘(6) incorporate the collection of data on cancer 

22 survivors for the purpose of improving the quality of 

23 cancer care; 

24 ‘‘(7) identify the impact of co-morbidity of 

25 other diseases on survival from cancer; or 
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1 ‘‘(8) develop methods of determining whether 

2 cancer survivors are at an increased risk for other 

3 chronic or disabling conditions. 

4 ‘‘(f) PRIVACY.—A State cancer registry receiving a 

5 grant or an entity receiving a contract under this section 

6 shall comply with appropriate security and privacy proto7 cols (including protocols required under the regulations

8 promulgated under section 264(c) of the Health Insurance 

9 Portability and Accountability Act of 1996 (42 U.S.C. 

10 1320d–2 note)), if applicable, with respect to information 

11 collected under this title. Nothing in this section shall be 

12 construed to supersede applicable Federal or State privacy 

13 laws. 

14 ‘‘(g) DATABASES.—

15 ‘‘(1) IN GENERAL.—In carrying out this sec16 tion, a State cancer registry may utilize appropriate 

17 databases, including— 

18 ‘‘(A) the National Death Index; 

19 ‘‘(B) databases related to claims under the 

20 medicare and medicaid programs under titles 

21 XVIII and XIX of the Social Security Act; and 

22 ‘‘(C) other databases maintained by the 

23 Department of Health and Human Services (in24 cluding those maintained at the Agency for 

25 Healthcare Research and Quality, the Centers 
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1 for Disease Control and Prevention, the Centers

2 for Medicare & Medicaid Services, and the Na3 tional Institutes of Health). 

4 ‘‘(2) ADDITIONAL DATA.—A State cancer reg5 istry may utilize data in addition to the databases 

6 described in paragraph (1), including data main7 tained by private insurance plans and health care 

8 delivery organizations. 

9 ‘‘(h) RULE OF CONSTRUCTION.—Nothing in this sec10 tion shall be construed to require an individual or entity 

11 to submit information to a State cancer registry under this 

12 section. 

13 ‘‘(i) DEFINITIONS.—In this section: 

14 ‘‘(1) HEALTH CENTER.—The term ‘health cen15 ter’ has the meaning given the term ‘federally quali16 fied health center’ in section 1861(aa)(4) of the So17 cial Security Act (12 U.S.C. 1395x(aa)(4)). 

18 ‘‘(2) QUALITY OF CANCER CARE.—The term 

19 ‘quality of cancer care’ has the meaning given such 

20 term in section 399AA. 

21 ‘‘(j) AUTHORIZATION OF APPROPRIATIONS.—There 

22 is authorized to be appropriated to carry out this section, 

23 such sums as may be necessary for each of fiscal years 

24 2006 through 2010. 
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1 ‘‘SEC. 399E–2. CANCER SURVEILLANCE SYSTEM. 

2 ‘‘(a) IN GENERAL.—The Secretary, acting through 

3 the Director of the Centers for Disease Control and Pre4 vention, and in coordination with the Director of the Na5 tional Cancer Institute, shall—

6 ‘‘(1) establish the Cancer Surveillance System 

7 (referred to in this section as the ‘System’) to mon8 itor State cancer registries funded under section 

9 399B; and 

10 ‘‘(2) provide for the development, expansion, 

11 and evaluation of such registries. 

12 ‘‘(b) DUTIES.—The System shall—

13 ‘‘(1) facilitate timely access to and exchange of 

14 accurate quality of cancer care information among 

15 State cancer registries including the use of the qual16 ity of cancer care measures developed under section 

17 417E, where appropriate; 

18 ‘‘(2) develop guidelines permitting State cancer 

19 registries to access the national registry clearing20 house established under paragraph (3); 

21 ‘‘(3) establish and maintain a registry informa22 tion clearinghouse to collect, synthesize, and dissemi23 nate information concerning evidence-based best 

24 practices for the creative use of State cancer reg25 istries, including maintaining an Internet website 

26 where such information may be accessed; 
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1 ‘‘(4) determine the feasibility of monitoring the 

2 quality of palliative care by State cancer registries; 

3 ‘‘(5) identify and develop evidence-based best 

4 practices for coordination between cancer registries 

5 and other entities; 

6 ‘‘(6) update information collected or made 

7 available under this section as determined to be nec8 essary by the Secretary; and 

9 ‘‘(7)(A) review pediatric cancer data collected 

10 by State cancer registries and evaluate—

11 ‘‘(i) such data for adequacy, completeness, 

12 timeliness, and quality; and 

13 ‘‘(ii) current efforts to aggregate and dis14 seminate such data; and 

15 ‘‘(B) not later than January 1, 2006, submit to 

16 Congress a report on the findings made under sub17 paragraph (A). 

18 ‘‘(c) PRIVACY.—The System shall comply with appro19 priate security and privacy protocols (including protocols 

20 required under the regulations promulgated under section 

21 264(c) of the Health Insurance Portability and Account22 ability Act of 1996 (42 U.S.C. 1320d–2 note)), if applica23 ble, with respect to information collected by the System. 

24 Nothing in this section shall be construed to supersede ap25 plicable Federal or State privacy laws. 
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1 ‘‘(d) DEFINITIONS.—In this section, the terms ‘pal2 liative care’ and ‘quality of cancer care’ have the meanings 

3 given such terms in section 399AA. 

4 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

5 is authorized to be appropriated to carry out this section, 

6 such sums as may be necessary for each of fiscal years 

7 2006 through 2010.’’. 

8 SEC. 202. REAUTHORIZATION OF NATIONAL PROGRAM OF 

9 CANCER REGISTRIES. 

10 Section 399F(a) of the Public Health Service Act (42 

11 U.S.C. 280e–4(a)) is amended—

12 (1) by striking ‘‘this part,’’ and inserting ‘‘this 

13 part, other than sections 399E–1 and 399E–2),’’; 

14 and 

15 (2) by striking ‘‘2003’’ and inserting ‘‘2010’’. 

16 SEC. 203. MATCHING FUNDS; RELATIONSHIP TO CERTIFI17 CATION. 

18 (a) MATCHING FUNDS.—Section 399B(b)(1) of the 

19 Public Health Service Act (42 U.S.C. 280e(B)(1)) is 

20 amended by striking ‘‘$3’’ and inserting ‘‘$5’’. 

21 (b) RELATIONSHIP TO CERTIFICATION.—Section 

22 399E of the Public Health Service Act (42 U.S.C. 280e–

23 3) is amended—

24 (1) by redesignating subsections (d) and (e) as 

25 subsections (e) and (f), respectively; and 
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•S 2771 IS 

1 (2) by inserting after subsection (c) the fol2 lowing: 

3 ‘‘(d) RELATIONSHIP TO CERTIFICATION.—The Cen4 ters for Disease Control and Prevention is encouraged to 

5 work with eligible entities through the provision of tech6 nical assistance and funding authority under the National 

7 Program of Cancer Registries to assist such entities in 

8 complying with the certification process of the North 

9 American Association of Central Cancer Registries or 

10 similar certification organization.’’.

11 TITLE III—MONITORING AND 

12 EVALUATING QUALITY OF 

13 CANCER CARE AND OUT14 COMES 

15 SEC. 301. PARTNERSHIPS TO DEVELOP MODEL SYSTEMS 

16 FOR MONITORING AND EVALUATING QUAL17 ITY OF CANCER CARE AND OUTCOMES. 

18 (a) QUALITY OF CANCER CARE.—Part A of title IX 

19 of the Public Health Service Act (42 U.S.C. 299 et seq.) 

20 is amended by adding at the end the following: 

21 ‘‘SEC. 904. AREAS OF SPECIAL EMPHASIS. 

22 ‘‘(a) QUALITY OF CANCER CARE.—The Secretary, 

23 acting through the Director and in collaboration with the 

24 Director of the Centers for Disease Control and Preven25 tion and the Director of the National Cancer Institute,
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•S 2771 IS 

1 shall conduct and support research pertaining to the meas2 urement, evaluation, and improvement of the quality of 

3 cancer care, take steps to enhance the usefulness of such 

4 research to improve patient care, and appropriately dis5 seminate such information by—

6 ‘‘(1) expanding the evidence base concerning ef7 fective interventions for improving the quality of 

8 cancer care; 

9 ‘‘(2) ensuring effective analysis of data collected 

10 by State cancer registries funded under section 

11 399B by developing evidence-based best practices 

12 for—

13 ‘‘(A) the real-time recording of and auto14 mated transfer of cancer care data to State 

15 cancer care registries; and 

16 ‘‘(B) the linkage of registry data with pri17 vate sector claims data and other existing data 

18 systems for purposes of analytic academic re19 search; 

20 ‘‘(3) developing and validating quality of cancer 

21 care indicators and evaluate their use and useful22 ness; and 

23 ‘‘(4) developing volume-based quality indicators, 

24 as appropriate, and evaluate ongoing efforts to inte25 grate volume-based measures into cancer quality im-
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1 provement programs and their impact on patient de2 cisionmaking. 

3 ‘‘(b) PARTNERSHIPS TO SPEED THE PACE OF IM4 PROVEMENTS IN THE QUALITY OF CANCER CARE.—

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

6 through the Director and in collaboration with the 

7 Director of the Centers for Disease Control and Pre8 vention and the Director of the National Cancer In9 stitute, shall award competitive grants, contracts, or 

10 enter into cooperative agreements with eligible enti11 ties to—

12 ‘‘(A) foster the development or adoption of 

13 model systems of cancer care; 

14 ‘‘(B) speed the pace of improvement in the 

15 quality of cancer care; or 

16 ‘‘(C) when appropriate, carry out the other 

17 requirements of this section. 

18 ‘‘(2) ELIGIBILITY.—In accordance with the lim19 itations of section 926(c), an applicant eligible to re20 ceive a grant, contract, or cooperative agreement 

21 under this subsection shall be a consortium con22 sisting of public- and private-sector entities. Each 

23 consortium shall include an institution of higher 

24 learning or other research entity and 1 or more of 

25 the following: 
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1 ‘‘(A) An entity that delivers or purchases 

2 cancer care. 

3 ‘‘(B) A professional society or societies 

4 that represent health care providers and other 

5 cancer caregivers, including hospice programs. 

6 ‘‘(C) A consumer or patient organization. 

7 ‘‘(D) An entity involved in the monitoring 

8 of quality of cancer care or efforts to improve 

9 cancer care (including a State or local health 

10 department). 

11 ‘‘(c) COLLABORATION.—In carrying out this section, 

12 the Secretary, acting through the Director, shall ensure 

13 coordination with appropriate Federal and State agencies, 

14 private quality improvement entities, and accreditation or 

15 licensure organizations with an interest in improving the 

16 quality of cancer care. 

17 ‘‘(d) DEFINITIONS.—In this section, the term ‘quality 

18 of cancer care’ has the meaning given such term in section 

19 399AA.’’. 

20 (b) AUTHORIZATION OF APPROPRIATIONS.—Section 

21 927 of the Public Health Service Act (42 U.S.C. 299c–

22 6) is amended by adding at the end the following: 

23 ‘‘(e) QUALITY OF CANCER CARE.—For the purpose 

24 of carrying out the activities under section 904, such sums 
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1 as may be necessary for each of fiscal years 2005 through 

2 2010.’’. 

3 TITLE IV—STRENGTHENING 

4 COMPREHENSIVE CANCER 

5 CONTROL 

6 SEC. 401. COMPREHENSIVE CANCER CONTROL PROGRAM. 

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

8 (42 U.S.C. 243 et seq.) is amended by adding at the end 

9 the following: 

10 ‘‘SEC. 320B. COMPREHENSIVE CANCER CONTROL PRO11 GRAM. 

12 ‘‘(a) ESTABLISHMENT.—The Secretary, acting 

13 through the Director of the Centers for Disease Control 

14 and Prevention and in consultation with the Director of 

15 the Agency for Healthcare Research and Quality and the 

16 Director of the National Cancer Institute, shall establish 

17 a National Comprehensive Cancer Control Program (re18 ferred to in this section as the ‘Program’) to improve the 

19 quality of cancer care. 

20 ‘‘(b) PROGRAM.—In carrying out the Program the 

21 Secretary shall—

22 ‘‘(1) establish guidelines regarding the design 

23 and implementation of comprehensive cancer control 

24 plans; and 
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1 ‘‘(2) award competitive grants to eligible enti2 ties to develop, update, implement, and evaluate 

3 comprehensive cancer control plans.

4 ‘‘(c) ELIGIBILITY.—An entity is eligible to receive as5 sistance under the Program if such entity is a State health 

6 department, territory, Indian tribe, or tribal organization 

7 or its designee. 

8 ‘‘(d) APPLICATION.—An eligible entity desiring a 

9 grant under this section shall submit an application to the 

10 Secretary at such time, in such manner, and containing 

11 such information as the Secretary may require, includ12 ing—

13 ‘‘(1) a description of how assistance under such 

14 grant will be used to develop and implement com15 prehensive cancer control programs, including pro16 grams to monitor the quality of cancer care (which 

17 may include the use of quality of cancer care meas18 ures developed under section 417E); 

19 ‘‘(2) a description of how the applicant will in20 tegrate its activities with academic institutions, non21 profit organizations, or other appropriate entities in 

22 planning and implementing comprehensive cancer 

23 control plans; and 

24 ‘‘(3) a description of how activities carried out 

25 by the applicant will be evaluated.
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1 ‘‘(e) USE OF FUNDS.—An entity shall use assistance 

2 received under this section to—

3 ‘‘(1) convene stakeholders, including stake4 holders from the public, private, and nonprofit sec5 tors, to determine priorities for the State, territory, 

6 or tribe involved; 

7 ‘‘(2) develop, update, implement, or evaluate 

8 comprehensive cancer control plans; 

9 ‘‘(3) assess disparities in cancer risk reduction, 

10 prevention, diagnosis, or quality of cancer care; and 

11 ‘‘(4) develop and disseminate best practices, 

12 where appropriate, and evaluate the application of 

13 such practices as necessary. 

14 ‘‘(f) DEFINITIONS.—In this section: 

15 ‘‘(1) COMPREHENSIVE CANCER CONTROL

16 PLAN.—The term ‘comprehensive cancer control 

17 plan’ means a plan developed with assistance pro18 vided under this section that provides for an inte19 grated and coordinated approach to reducing the in20 cidence, morbidity, and mortality of cancer, with a 

21 particular emphasis on preventing and controlling 

22 cancer among populations most at risk and reducing 

23 cancer disparities among underserved populations. 

24 ‘‘(2) COMPREHENSIVE CANCER CONTROL PRO25 GRAM.—The term ‘comprehensive cancer control 
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1 program’ means a program to fulfill the comprehen2 sive control plan. 

3 ‘‘(3) QUALITY OF CANCER CARE.—The term 

4 ‘quality of cancer care’ has the meaning given such 

5 term in section 399AA. 

6 ‘‘(4) INDIAN TRIBE; TRIBAL ORGANIZATION.—

7 The terms ‘Indian tribe’ and ‘tribal organization’ 

8 have the meanings given such terms in subsections 

9 (b) and (c) of section 4 of the Indian Self-Deter10 mination and Education Assistance Act (25 U.S.C. 

11 450b). 

12 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 

13 is authorized to be appropriated to carry out this section, 

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

15 2006 through 2010.’’. 

16 TITLE V—IMPROVING NAVIGA17 TION AND SYSTEM COORDI18 NATION 

19 SEC. 501. ENHANCING CANCER CARE THROUGH IMPROVED 

20 NAVIGATION AND CANCER CARE COORDINA21 TION. 

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

23 241 et seq.) is amended by adding at the end the fol24 lowing: 
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1 ‘‘PART R—CANCER PREVENTION AND TREATMENT

2 ‘‘SEC. 399AA. DEFINITIONS; AUTHORIZATION OF APPRO3 PRIATIONS. 

4 ‘‘(a) DEFINITIONS.—In this part: 

5 ‘‘(1) CULTURALLY COMPETENT.—The term 

6 ‘culturally competent’, with respect to the manner in 

7 which health-related services, education, and train8 ing are provided, means providing the services, edu9 cation, and training in the language and cultural 

10 context that is most appropriate for the individuals 

11 for whom the services, education, and training are 

12 intended. 

13 ‘‘(2) HEALTH CENTER.—The term ‘health cen14 ter’ has the meaning given such term in section 

15 399E–1. 

16 ‘‘(3) HEALTH DISPARITY POPULATION.—The 

17 term ‘health disparity population’ has the meaning 

18 given such term in section 903(d)(1). 

19 ‘‘(4) HEALTH DISPARITIES RESEARCH.—The 

20 term ‘health disparities research’ means basic, clin21 ical, and behavioral research on health conditions 

22 disproportionately affecting individuals from health 

23 disparity populations, including research to prevent, 

24 diagnose, and treat such conditions. Such health 

25 conditions shall include all diseases, disorders, and 
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1 conditions affecting individuals from health disparity 

2 populations that are—

3 ‘‘(A) unique to, more serious, or more 

4 prevalent in such individuals; 

5 ‘‘(B) for which the factors of medical risk 

6 or types of medical intervention may be dif7 ferent for such individuals, or for which it is 

8 unknown whether such factors or types are dif9 ferent for such individuals; or 

10 ‘‘(C) with respect to which there has been 

11 insufficient research involving such individuals 

12 as subjects or insufficient data on such individ13 uals. 

14 ‘‘(5) HOSPICE CARE.—The term ‘hospice care’ 

15 has the meaning given such term in section 

16 1861(dd)(1) of the Social Security Act (42 U.S.C. 

17 1395x(dd)(1)). 

18 ‘‘(6) HOSPICE PROGRAM.—The term ‘hospice 

19 program’ has the meaning given such term in sec20 tion 1861(dd)(2) of the Social Security Act (42 

21 U.S.C. 1395x(dd)(2)). 

22 ‘‘(7) PALLIATIVE CARE.—The term ‘palliative 

23 care’ means comprehensive, interdisciplinary, coordi24 nated, and appropriate care and services provided 

25 throughout all stages of disease, from the time of di-
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1 agnosis to the end of life, relating to pain and other 

2 symptom management, including psychosocial needs, 

3 that seeks to improve quality of life and prevent and 

4 alleviate suffering for an individual and, if appro5 priate, that individual’s family or caregivers. 

6 ‘‘(8) QUALITY OF CANCER CARE.—The term 

7 ‘quality of cancer care’ means the provision of can8 cer-related, timely, evidence-based (whenever there is 

9 scientific evidence on the effectiveness of interven10 tions), patient-centered care and services of individ11 uals in a technically and culturally competent and 

12 appropriate manner, using effective communication 

13 and shared decisionmaking to improve clinical out14 comes, survival, or quality of life which encom15 passes—

16 ‘‘(A) the various stages of care, including 

17 care and services provided to individuals with a 

18 family history of cancer, with an abnormal can19 cer screening test, or who are clinically diag20 nosed with cancer, beginning with risk reduc21 tion, prevention, and early detection through 

22 survivorship, remission, and end-of-life care, 

23 and including risk counseling, screening, diag24 nosis, treatment, followup care, monitoring, re25 habilitation, and hospice care; and
26

•S 2771 IS 

1 ‘‘(B) appropriate care and services which 

2 should be provided throughout the continuum of 

3 care including palliative care and information 

4 on treatment options including information re5 garding clinical trials.

6 ‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There 

7 are authorized to be appropriated to carry out this part, 

8 other than section 399FF, such sums as may be necessary 

9 for each of fiscal years 2006 through 2010. 

10 ‘‘SEC. 399BB. ENHANCING CANCER CARE THROUGH IM11 PROVED NAVIGATION. 

12 ‘‘(a) DEMONSTRATION PROJECTS.—The Secretary 

13 shall award competitive grants to eligible entities to de14 velop, implement, and evaluate cancer case management 

15 programs to enhance the quality of cancer care through 

16 improved access and navigation. 

17 ‘‘(b) ELIGIBILITY.—An entity is eligible to receive a 

18 grant under this section if such entity is a hospital; health 

19 center; an academic institution; a hospice program; a pal20 liative care program, or a program offering a continuum 

21 of hospice care, palliative care, and other appropriate care 

22 to children and their families; a State health agency; an 

23 Indian Health Service hospital or clinic, Indian tribal 

24 health facility, or urban Indian facility; a nonprofit organi25 zation; a health plan; a primary care practice-based re-
27

•S 2771 IS 

1 search network as defined by the Agency for Healthcare 

2 Research and Quality; a cancer center; or any other entity 

3 determined to be appropriate by the Secretary. 

4 ‘‘(c) APPLICATION.—An eligible entity seeking a 

5 grant under this section shall submit an application to the 

6 Secretary at such time, in such manner, and containing 

7 such information as the Secretary may require, including 

8 assurances that the eligible entity will—

9 ‘‘(1) target patient populations with an unequal 

10 burden of cancer through specific outreach activities; 

11 ‘‘(2) coordinate culturally competent and appro12 priate care specified in observance of existing, rel13 evant departmental guidelines, including a special 

14 emphasis on underserved populations and how their 

15 values and priorities influence screening and treat16 ment decisions; 

17 ‘‘(3) coordinate with relevant ombudsman pro18 grams and other existing coordination and naviga19 tion efforts and services, where possible; and 

20 ‘‘(4) evaluate activities and disseminate findings 

21 including findings related to repeated difficulties in 

22 accessing navigation. 

23 ‘‘(d) USE OF FUNDS.—An eligible entity shall use 

24 amounts received under a grant under this section to carry 

25 out programs in which— 
28

•S 2771 IS 

1 ‘‘(1) trained individuals (such as representatives 

2 from the community, nurses, social workers, cancer 

3 survivors, physicians, or patient advocates) are as4 signed to act as contacts—

5 ‘‘(A) within the community; or 

6 ‘‘(B) within the health care system, 

7 to facilitate access to quality cancer care and cancer 

8 preventive services; 

9 ‘‘(2) partnerships are created with community 

10 organizations (which may include cancer centers, 

11 hospitals, health centers, hospice programs, pallia12 tive care programs, health care providers, home care, 

13 nonprofit organizations, health plans, or other enti14 ties determined appropriate by the Secretary) to 

15 help facilitate access or to improve the quality of 

16 cancer care; 

17 ‘‘(3) activities are conducted to coordinate can18 cer care and preventive services and referrals, in19 cluding referrals to hospice programs, and palliative 

20 care programs; or 

21 ‘‘(4) the grantee negotiates, mediates, or arbi22 trates on behalf of the patient with relevant entities 

23 to resolve issues that impede access to care. 

24 ‘‘(e) MODELS.—Not later than 3 years after the date 

25 of enactment of this section, the Secretary shall develop 
29

•S 2771 IS 

1 or modify models to improve the navigation of cancer care 

2 for grantees under this section. The Secretary shall update 

3 such models as may be necessary to ensure that the best 

4 cancer case management practices are being utilized. 

5 ‘‘SEC. 399CC. CANCER CARE COORDINATION. 

6 ‘‘(a) DEMONSTRATION PROJECTS.—The Secretary 

7 shall award competitive grants to eligible entities to facili8 tate the development of a coordinated system to improve 

9 the quality of cancer care. 

10 ‘‘(b) ELIGIBILITY.—An entity is eligible to receive a 

11 grant under this section if such entity is a hospital; a 

12 health center; an academic institution; a hospice program; 

13 a palliative care program; a program offering a continuum 

14 of hospice care, palliative care, and other appropriate care 

15 to children and their families; a State health agency; a 

16 nonprofit organization; a health plan; a primary care prac17 tice-based research network as defined by the Agency for 

18 Healthcare Research and Quality; a cancer center; or any 

19 other entity determined to be appropriate by the Sec20 retary. 

21 ‘‘(c) APPLICATION.—An eligible entity desiring a 

22 grant under this section shall prepare and submit to the 

23 Secretary an application at such time, in such manner, 

24 and containing such information as the Secretary may re25 quire. 
30

•S 2771 IS 

1 ‘‘(d) USE OF FUNDS.—An eligible entity shall use 

2 amounts received under a grant under this section to im3 prove coordination of the quality of cancer care, by—

4 ‘‘(1) creating partnerships and enhancing col5 laboration with health care providers (which may in6 clude cancer centers, hospitals, health centers, hos7 pice programs, health care providers, experts in pal8 liative care, preventive service providers) to improve 

9 the provision of quality of cancer care; 

10 ‘‘(2) developing best practices for the quality of 

11 cancer care coordination (with special emphasis pro12 vided to those cancers that have low survival rates 

13 or individuals with advanced disease), including the 

14 development of model systems; and 

15 ‘‘(3) evaluating overall activities to identify op16 timal designs and essential components for cancer 

17 practices and models to improve the coordination of 

18 cancer care services and activities. 

19 ‘‘(e) DISSEMINATION.—The Secretary shall dissemi20 nate findings made as a result of activities conducted 

21 under this section to the public in coordination with the 

22 Agency for Healthcare Research and Quality, the Centers 

23 for Medicare & Medicaid Services, or other appropriate 

24 Federal agencies.’’.
31

•S 2771 IS 

1 TITLE VI—ESTABLISHING PRO2 GRAMS IN PALLIATIVE CARE 

3 SEC. 601. PROGRAMS TO IMPROVE PALLIATIVE CARE. 

4 Part R of title III of the Public Health Service Act 

5 (as added by section 501), is further amended by adding 

6 at the end the following:

7 ‘‘SEC. 399DD. PROGRAMS TO IMPROVE PALLIATIVE CARE. 

8 ‘‘(a) DEMONSTRATION PROJECTS.—The Secretary 

9 shall award competitive grants to eligible entities to de10 velop, implement, and evaluate model programs for the de11 livery of palliative care throughout all stages of disease 

12 for individuals with cancer (with a special emphasis on 

13 children) and their families. 

14 ‘‘(b) ELIGIBILITY.—An entity is eligible to receive a 

15 grant under this section if such entity is a hospital; an 

16 academic institution; a hospice program; a palliative care 

17 program; a program offering a continuum of hospice care, 

18 palliative care, and other appropriate care to children and 

19 their families; a nonprofit organization; a State health 

20 agency; a health center; a cancer center; or any other enti21 ty determined to be appropriate by the Secretary. 

22 ‘‘(c) APPLICATION.—An eligible entity desiring a 

23 grant under this section shall prepare and submit to the 

24 Secretary an application at such time, in such manner, 
32

•S 2771 IS 

1 and containing such information as the Secretary may re2 quire. 

3 ‘‘(d) USE OF FUNDS.—An entity shall use amounts 

4 received under a grant under this section to—

5 ‘‘(1) integrate palliative care with such entities 

6 as academic institutions, community organizations, 

7 hospice programs, hospitals, cancer patient and sur8 vivorship organizations, health care providers, cancer 

9 centers, or other entities determined appropriate by 

10 the Secretary; 

11 ‘‘(2) conduct outreach and education activities 

12 to encourage the dissemination of evidence-based 

13 clinical best practices relating to palliative care; 

14 ‘‘(3) increase public awareness, including out15 reach campaigns, particularly to underserved popu16 lations; 

17 ‘‘(4) disseminate evidence-based information to 

18 health care providers and individuals with cancer 

19 and their families regarding available palliative care 

20 programs and services; 

21 ‘‘(5) provide and evaluate education and train22 ing programs in palliative care for health care pro23 viders, including—

24 ‘‘(A) establishing pilot training programs 

25 (including faculty training programs) in medi-
33

•S 2771 IS 

1 cine, including oncology (including pediatric on2 cology), family medicine, psychiatry, psychology, 

3 pain, nursing, pharmacology, physical therapy, 

4 occupational therapy, social work, and other rel5 evant disciplines; or 

6 ‘‘(B) developing, implementing, and evalu7 ating pilot training programs for the staff of 

8 hospices, nursing homes, hospitals, home health 

9 agencies, outpatient care clinics, and other enti10 ties determined appropriate by the Secretary; 

11 ‘‘(6) design or implement model palliative care 

12 programs for individuals with cancer and their fami13 lies including improving access to clinical trials, 

14 where appropriate; 

15 ‘‘(7) develop and evaluate pilot programs to ad16 dress the special needs of children or other under17 served populations and their families in palliative 

18 care programs; 

19 ‘‘(8) conduct demonstration projects to enhance 

20 or develop online support networks for individuals 

21 with cancer and their families, including those net22 works for individuals who are homebound, and de23 velop other methods to reach underserved cancer pa24 tients; or 
34

•S 2771 IS 

1 ‘‘(9) determine whether strategies developed for 

2 palliative care for individuals with cancer and their 

3 families would be applicable to individuals with other 

4 diseases. 

5 ‘‘(e) DISSEMINATION.—The Secretary shall dissemi6 nate findings made as a result of activities conducted 

7 under this section to the public in coordination with the 

8 Director of the Agency for Healthcare Research and Qual9 ity, the Administrator of the Centers for Medicare & Med10 icaid Services, and the heads other appropriate Federal 

11 agencies.’’. 

12 TITLE VII—ESTABLISHING 

13 SURVIVORSHIP PROGRAMS 

14 SEC. 701. PROGRAMS FOR SURVIVORSHIP. 

15 Subpart 1 of Part C of title IV of the Public Health 

16 Service Act (42 U.S.C. 285 et seq.) (as amended by sec17 tion 101), is further amended by adding at the end the 

18 following: 

19 ‘‘SEC. 417F. PROGRAMS FOR SURVIVORSHIP. 

20 ‘‘(a) DEMONSTRATION PROJECTS.—The Secretary 

21 shall conduct and support research regarding the unique 

22 health challenges associated with cancer survivorship and 

23 carry out demonstration projects to develop and imple24 ment post-treatment public health programs and services 

25 including followup care and monitoring to support and im-
35

•S 2771 IS 

1 prove the long-term quality of life for cancer survivors, 

2 including children. 

3 ‘‘(b) ELIGIBILITY.—An entity is eligible to receive a 

4 competitive grant under this section if such entity is an 

5 academic institution, nonprofit organization, State health 

6 agency, cancer center, health center, or other entity deter7 mined to be appropriate by the Secretary. 

8 ‘‘(c) APPLICATION.—An entity desiring a grant under 

9 this section shall prepare and submit to the Secretary an 

10 application at such time, in such manner, and containing 

11 such information as the Secretary may require. 

12 ‘‘(d) USE OF FUNDS.—An entity shall use amounts 

13 received under a grant under this section to plan, imple14 ment, and evaluate demonstration projects that—

15 ‘‘(1) design protocols for followup care, moni16 toring, and other survivorship programs (including 

17 peer support and mentor programs); 

18 ‘‘(2) increase public awareness about appro19 priate followup care, monitoring and other survivor20 ship programs (including peer support and mentor 

21 programs) by disseminating information to health 

22 care providers and survivors and their families; and 

23 ‘‘(3) support programs to improve the quality of 

24 life among cancer survivors, referenced by the qual25 ity of cancer care measures developed under section
36

•S 2771 IS 

1 417E (where appropriate), with particular emphasis 

2 on underserved populations, including children. 

3 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

4 are authorized to be appropriated to carry out this section, 

5 such sums as may be necessary for each of fiscal years 

6 2006 through 2010.’’. 

7 SEC. 702. CANCER CONTROL PROGRAMS. 

8 Section 412 of the Public Health Service Act (42 

9 U.S.C. 285a–1) is amended—

10 (1) in the matter preceding paragraph (1), by 

11 striking ‘‘cancer and for rehabilitation and coun12 seling respecting cancer.’’ and inserting ‘‘cancer and 

13 for survivorship, rehabilitation, and counseling re14 specting cancer.’’; 

15 (2) in paragraph (1)(B), by striking ‘‘and the 

16 families of cancer patients’’ and inserting ‘‘the fami17 lies of cancer patients, and cancer survivors’’; and 

18 (3) in paragraph (3), by striking ‘‘diagnosis, 

19 and treatment and control of cancer’’ and inserting 

20 ‘‘diagnosis, treatment, survivorship programs, and 

21 control of cancer.’’. 
37

•S 2771 IS 

1 TITLE VIII—PROGRAMS FOR 

2 END-OF-LIFE CARE 

3 SEC. 801. PROGRAMS FOR END-OF-LIFE CARE. 

4 Part R of title III of the Public Health Service Act 

5 (as amended by section 601), is further amended by add6 ing the following: 

7 ‘‘SEC. 399EE. PROGRAMS FOR END-OF-LIFE CARE. 

8 ‘‘(a) DEMONSTRATION PROJECTS.—The Secretary 

9 shall award competitive grants to eligible entities to de10 velop, implement, and evaluate evidence-based programs 

11 for the delivery of quality of cancer care during the end12 of-life to individuals with cancer (with a special emphasis 

13 on children) and their families. 

14 ‘‘(b) ELIGIBILITY.—An entity is eligible to receive a 

15 grant under this section if such entity is a hospital; an 

16 academic institution; a hospice program; a palliative care 

17 program; a program offering a continuum of hospice care, 

18 palliative care, and other appropriate care to children and 

19 their families; a nonprofit organization; a State health 

20 agency; a health center; a cancer center; or any other enti21 ty determined to be appropriate by the Secretary. 

22 ‘‘(c) APPLICATION.—An entity desiring a grant under 

23 this section shall prepare and submit to the Secretary an 

24 application at such time, in such manner, and containing 

25 such information as the Secretary may require. 
38

•S 2771 IS 

1 ‘‘(d) USE OF FUNDS.—An entity shall use amounts 

2 received under a grant under this section to—

3 ‘‘(1) integrate palliative care or end-of-life care 

4 programs with entities including academic institu5 tions, community organizations, hospice programs, 

6 hospitals, cancer patient and survivorship organiza7 tions, health care providers, cancer centers, or other 

8 entities determined appropriate by the Secretary; 

9 ‘‘(2) conduct outreach and education activities 

10 to encourage the dissemination of evidence-based 

11 clinical best practices relating to end-of-life care; 

12 ‘‘(3) increase public awareness, including out13 reach campaigns, particularly to underserved popu14 lations; 

15 ‘‘(4) disseminate information to health care 

16 providers and individuals with cancer and their fami17 lies regarding available end-of-life programs, includ18 ing hospice programs; 

19 ‘‘(5) provide and evaluate education and train20 ing in end-of-life care for health care providers, in21 cluding—

22 ‘‘(A) establishing pilot training programs 

23 (including faculty training programs) in medi24 cine including oncology (including pediatric on25 cology), family medicine, psychiatry, psychology, 
39

•S 2771 IS 

1 pain, nursing, pharmacology and social work, 

2 and other disciplines; or 

3 ‘‘(B) developing, implementing, and evalu4 ating pilot training programs for the staff of 

5 hospices, nursing homes, hospitals, home health 

6 agencies, outpatient care clinics, and other enti7 ties determined appropriate by the Secretary; 

8 ‘‘(6) design or implement model end-of-life care 

9 programs for individuals with cancer and their fami10 lies including improving access to clinical trials 

11 where appropriate; 

12 ‘‘(7) develop and evaluate pilot programs to ad13 dress the special needs of children or other under14 served populations and their families in end-of-life 

15 programs; 

16 ‘‘(8) integrate palliative care and hospice care 

17 activities in the delivery of end-of-life care; or 

18 ‘‘(9) determine whether strategies developed for 

19 end-of-life care for individuals with cancer and their 

20 families would be applicable to individuals with other 

21 diseases. 

22 ‘‘(e) DISSEMINATION.—The Secretary shall dissemi23 nate findings made as a result of activities conducted 

24 under this section to the public in coordination with the 

25 Director of the Agency for Healthcare Research and Qual-
40

•S 2771 IS 

1 ity, the Administrator of the Centers for Medicare & Med2 icaid Services, and the heads of other appropriate Federal 

3 agencies.’’. 

4 TITLE IX—DEVELOPING 

5 TRAINING CURRICULA 

6 SEC. 901. CURRICULUM DEVELOPMENT. 

7 Part R of title III of the Public Health Service Act 

8 (as amended by section 801), is further amended by add9 ing at the end the following: 

10 ‘‘SEC. 399FF. CURRICULUM DEVELOPMENT. 

11 ‘‘(a) IN GENERAL.—The Secretary shall award com12 petitive grants for the development of curricula for health 

13 care provider training regarding the assessment, moni14 toring, improvement, and delivery of quality of cancer 

15 care. 

16 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 

17 under this section, an entity shall be an academic institu18 tion, nonprofit organization, cancer center, health center, 

19 medical school, or other entity determined appropriate by 

20 the Secretary. 

21 ‘‘(c) APPLICATION.—An entity desiring a grant under 

22 this section shall prepare and submit to the Secretary an 

23 application at such time, in such manner, and containing 

24 such information as the Secretary may require.
41

•S 2771 IS 

1 ‘‘(d) USE OF FUNDS.—An entity shall use amounts 

2 received under a grant under this subsection to—

3 ‘‘(1) evaluate methods of delivery of the quality 

4 of cancer care, including palliative care, hospice 

5 care, end-of-life care, or cancer survivorship by 

6 health care providers; 

7 ‘‘(2) develop curricula concerning the delivery of 

8 quality of cancer care including palliative care, hos9 pice care, end-of-life care, or cancer survivorship; 

10 and

11 ‘‘(3) provide recommendations for training pro12 tocols for medical and nursing education, fellow13 ships, and continuing education in quality of cancer 

14 care including palliative care, hospice care, survivor15 ship, or end-of-life care for health care providers. 

16 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

17 is authorized to be appropriated to carry out this section, 

18 such sums as may be necessary for each of fiscal years 

19 2006 through 2010.’’. 

20 SEC. 902. CANCER CARE WORKFORCE AND 

21 TRANSLATIONAL RESEARCH. 

22 (a) CANCER CONTROL PROGRAMS.—Section 412 of 

23 the Public Health Service Act (42 U.S.C. 285a–1) is 

24 amended—
42

•S 2771 IS 

1 (1) by striking ‘‘The Director of the Institute’’ 

2 and inserting the following: 

3 ‘‘(a) IN GENERAL.—The Director of the Institute’’; 

4 (2) by striking paragraph (2) and inserting the 

5 following: 

6 ‘‘(2) annual and long-term training goals to as7 sure an adequate and diverse cancer care workforce 

8 including—

9 ‘‘(A) preparing and implementing a plan to 

10 provide assistance to health professionals in 

11 health professions experiencing the most severe 

12 shortages including the provision of grants, 

13 scholarships, fellowships, post-doctoral stipends, 

14 or loans to eligible individuals to increase the 

15 cancer care workforce; and 

16 ‘‘(B) educating students of health profes17 sions and health professionals in—

18 ‘‘(i) effective methods for the preven19 tion and early detection of cancer; 

20 ‘‘(ii) the identification of individuals 

21 with a high risk of developing cancer; 

22 ‘‘(iii) improved methods of patient re23 ferral to appropriate centers for early diag24 nosis and treatment of cancer; 
43

•S 2771 IS 

1 ‘‘(iv) methods to deliver culturally 

2 competent care; and 

3 ‘‘(v) other appropriate methods for 

4 providing quality of cancer care; and’’; and 

5 (3) by adding at the end the following: 

6 ‘‘(b) COORDINATION WITH EXISTING PROGRAMS.—

7 In carrying out the activities under subsection (a)(2), the 

8 Director of the Institute shall coordinate with existing pro9 grams, including programs at the Health Resources and 

10 Services Administration, to prevent duplication.’’. 

11 (b) NATIONAL CANCER RESEARCH AND DEMONSTRA12 TION CENTERS.—Section 414(b) of the Public Health 

13 Service Act (42 U.S.C. 285a–3(b)) is amended by striking 

14 paragraph (3) and inserting the following: 

15 ‘‘(3) clinical training (including training for al16 lied health professionals), loan forgiveness or post17 doctoral stipends for bench researchers, continuing 

18 education for health professionals and allied health 

19 professionals, and information programs for the pub20 lic regarding cancer; and’’. 

21 (c) TRANSLATIONAL CANCER RESEARCH.—Subpart 

22 1 of part C of title IV of the Public Health Service Act 

23 (42 U.S.C. 285 et seq.) is amended by inserting after sec24 tion 414 the following: 
44

•S 2771 IS 

1 ‘‘SEC. 414A. TRANSLATIONAL CANCER RESEARCH. 

2 ‘‘(a) IN GENERAL.—The Director of the Institute, in 

3 collaboration with the Director of the Agency for 

4 Healthcare Research and Quality shall enter into coopera5 tive agreements with, and make grants to, public or non6 profit entities to conduct multidisciplinary, translational 

7 cancer research. 

8 ‘‘(b) USE OF FUNDS.—

9 ‘‘(1) IN GENERAL.—The Director of the Insti10 tute may use funds provided under this section to 

11 establish networks and partnerships to link commu12 nity cancer providers to programs funded under this 

13 section. 

14 ‘‘(2) CONSTRUCTION OF NEW FACILITIES.—

15 Funds provided under this section shall not be used 

16 for the construction of new facilities. 

17 ‘‘(c) STRATEGIC PLAN.—Not later than October 1, 

18 2006, the Director of the Institute shall develop and im19 plement a strategic plan, in collaboration with entities per20 forming translational research, for identifying, expanding, 

21 and disseminating the results of translational cancer re22 search to health care providers. 

23 ‘‘(d) DUTIES.—An entity receiving a grant under this 

24 section shall—

25 ‘‘(1) conduct research with the potential to im26 prove the prevention, diagnosis, and treatment of 
45

•S 2771 IS 

1 cancer and to improve the quality of cancer care, in2 cluding palliation; 

3 ‘‘(2) conduct clinical research studies on prom4 ising cancer treatments including clinical trials; and 

5 ‘‘(3) evaluate tests, techniques, or technologies 

6 in individuals being evaluated for the presence of 

7 cancer. 

8 ‘‘(e) DEFINITION OF TRANSLATIONAL CANCER RE9 SEARCH.—As used in this section, the term ‘translational 

10 cancer research’ means scientific laboratory and clinical 

11 research and testing necessary to transform scientific or 

12 medical discoveries into new approaches, products, or 

13 processes that can assist in preventing, diagnosing, or con14 trolling cancer.’’

15 (d) AUTHORIZATION OF APPROPRIATIONS.—Section 

16 417B(a) of the Public Health Service Act (42 U.S.C. 

17 285a–8(a)) is amended by striking ‘‘1996’’ and inserting 

18 ‘‘2010’’.
46

•S 2771 IS 

1 TITLE X—BREAST AND 

2 CERVICAL CANCER 

3 SEC. 1001. WAIVERS RELATING TO GRANTS FOR PREVEN4 TIVE HEALTH MEASURES WITH RESPECT TO 

5 BREAST AND CERVICAL CANCERS. 

6 (a) IN GENERAL.—Section 1503 of the Public Health 

7 Service Act (42 U.S.C. 300m) is amended by adding at 

8 the end the following: 

9 ‘‘(d) WAIVER OF SERVICES REQUIREMENT ON DIVI10 SION OF FUNDS.—

11 ‘‘(1) IN GENERAL.—The Secretary may waive 

12 the requirements under paragraphs (1) and (4) of 

13 subsection (a) if—

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

15 waiver to leverage private funds to supplement 

16 each of the services or activities described in 

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

18 ‘‘(ii) the application of such requirement 

19 would result in a barrier to the enrollment of 

20 qualifying women; 

21 ‘‘(B) the Secretary finds that granting 

22 such a waiver to a State will not reduce the 

23 number of women in the State that receive each 

24 of the services or activities described in para25 graphs (1) and (2) of section 1501(a), including 
47

•S 2771 IS 

1 making available screening procedures for both 

2 breast and cervical cancers; and 

3 ‘‘(C) 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 of 2 years; and 

13 ‘‘(ii) upon request of a State, may ex14 tend a waiver for additional 2-year periods 

15 in accordance with subparagraph (B). 

16 ‘‘(B) ADDITIONAL PERIODS.—The Sec17 retary, upon the request of a State that has re18 ceived a waiver under paragraph (1), shall, at 

19 the end of each 2-year waiver period described 

20 in subparagraph (A), review performance under 

21 the waiver and may extend the waiver for an 

22 additional 2-year period if the Secretary deter23 mines that—
48

•S 2771 IS 

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

2 waiver, there will be a barrier to the enroll3 ment of qualifying women; or 

4 ‘‘(II) the State requesting such ex5 tended waiver will use the waiver to lever6 age private funds to supplement each of 

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

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

10 reduce the number of women in the State 

11 that receive each of the services or activi12 ties described in paragraphs (1) and (2) of 

13 section 1501(a); and 

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

15 result in lower quality in the State of each 

16 of the services or activities described in 

17 paragraphs (1) and (2) of section 1501(a). 

18 ‘‘(3) REPORTING REQUIREMENT.—The Sec19 retary shall include as part of the evaluations and 

20 reports required under section 1508, the following: 

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

22 dollars leveraged annually from private entities 

23 in States receiving a waiver under paragraph 

24 (1) and how these amounts were used. 
49

•S 2771 IS 

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

2 waiver under paragraph (1), a description of 

3 the percentage of the grant that is expended on 

4 providing each of the services or activities de5 scribed in paragraphs (1) and (2) and para6 graphs (3) through (6) of section 1501(a). 

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

8 receiving waivers under paragraph (1) annually. 

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

10 waiver under paragraph (1), a description of 

11 the number of women receiving services under 

12 paragraphs (1), (2), and (3) of section 1501(a) 

13 in programs before and after the granting of 

14 such waiver.’’. 

15 (b) AUTHORIZATION OF APPROPRIATIONS.—Section 

16 1510(a) of the Public Health Service Act (42 U.S.C. 

17 300n-5(a)) is amended by striking ‘‘$50,000,000’’ and all 

18 that follows through the period, and inserting ‘‘such sums 

19 as may be necessary for each of fiscal years 2004 through 

20 2009.’’.
50

•S 2771 IS 

1 TITLE XI—COLORECTAL CANCER 

2 SEC. 1101. PROGRAMS TO IMPROVE COLORECTAL CANCER 

3 SCREENING. 

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

5 300k et seq.) is amended by adding at the end the fol6 lowing: 

7 ‘‘SEC. 1511. COLORECTAL CANCER SCREENING DEM8 ONSTRATION PROJECT. 

9 ‘‘(a) IN GENERAL.—The Secretary, acting through 

10 the Director of the Centers for Disease Control and Pre11 vention, shall award competitive grants to public and non12 profit private entities to enable such entities to establish 

13 demonstration programs pursuant to the general authority 

14 of title III to carry out colorectal screening activities in15 cluding—

16 ‘‘(1) screening asymptomatic individuals as de17 termined by the Secretary in accordance with cat18 egory A or B recommendation rating of the U.S. 

19 Preventive Service Task Force or as otherwise deter20 mined by the Secretary; 

21 ‘‘(2) providing appropriate case management 

22 and referrals for medical treatment of individuals 

23 screened pursuant to this section; 

24 ‘‘(3) establishing activities to improve the edu25 cation, training, and skills of health professionals 
51

•S 2771 IS 

1 (including allied health professionals) in the detec2 tion and control of colorectal cancer, as a part of 

3 their participation in the screening program estab4 lished under the grant; 

5 ‘‘(4) evaluating the programs under this section 

6 through appropriate surveillance or program moni7 toring activities; 

8 ‘‘(5) developing and disseminating findings de9 rived through such evaluations and outcomes data 

10 collection; and 

11 ‘‘(6) promoting the benefits of and participation 

12 in the colorectal cancer screening program estab13 lished under the grant. 

14 ‘‘(b) REQUIREMENTS.—

15 ‘‘(1) PRIORITY.—To be eligible for a grant 

16 under subsection (a), an entity shall agree with re17 spect to activities and services under the grant to 

18 target low-income—

19 ‘‘(A) individuals who are at least 50 years 

20 of age; or 

21 ‘‘(B) individuals at high risk for colorectal 

22 cancer (as defined in section 1861(pp)(2) of the 

23 Social Security Act (42 U.S.C. 1395x(pp)(2))). 

24 ‘‘(2) RELATIONSHIP TO ITEMS AND SERVICES

25 UNDER OTHER PROGRAMS.—To be eligible for a 
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1 grant under subsection (a), an entity shall agree 

2 that grant funds will not be expended to make pay3 ments for any item or service to the extent that pay4 ment has been made, or can reasonably be expected 

5 to be made, with respect to such item or service—

6 ‘‘(A) under any State compensation pro7 gram, under an insurance policy, or under any 

8 Federal or State health benefits program; or 

9 ‘‘(B) by an entity that provides health 

10 service on a prepaid basis. 

11 ‘‘(3) RECORDS AND AUDITS.—To be eligible for 

12 a grant under subsection (a), an entity shall agree 

13 that the entity will—

14 ‘‘(A) establish such fiscal control and fund 

15 accounting procedures as may be necessary to 

16 ensure proper disbursal of, and accounting for, 

17 amounts received under this section; and 

18 ‘‘(B) provide agreed upon annual reports 

19 to the Secretary or the Comptroller of the

20 United States for the purposes of auditing the 

21 expenditures by the entity. 

22 ‘‘(4) REPORTS.—To be eligible for a grant 

23 under subsection (a), an entity shall agree to submit 

24 to the Secretary such reports as the Secretary deter25 mines appropriate. 
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1 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 

2 is authorized to be appropriated to carry out this section, 

3 such sums as may be necessary for each of fiscal years 

4 2005 through 2009.’’. 

5 TITLE XII—CONDUCTING 

6 REPORTS 

7 SEC. 1201. STUDIES AND REPORTS BY THE INSTITUTE OF 

8 MEDICINE. 

9 (a) CONTRACT.—The Secretary shall enter into a 

10 contract with the Institute of Medicine to— 

11 (1) evaluate Federal and State activities relat12 ing to comprehensive cancer control programs and 

13 activities; 

14 (2) evaluate the quality of cancer care (includ15 ing palliative care, end-of-life care, and survivorship) 

16 that medicare and medicaid beneficiaries receive and 

17 the extent to which medicare and medicaid coverage 

18 and reimbursement policies affect access to quality 

19 cancer care; 

20 (3) evaluate data from the Centers for Medicare 

21 & Medicaid Services and other agencies on volume22 outcome relationships;

23 (4) evaluate access to clinical trials and the re24 lationship of such access to the quality of cancer 
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1 care, especially with respect to health disparity pop2 ulations; and 

3 (5) assess existing gaps in and impediments to 

4 the quality of cancer care, including gaps in data, 

5 research and translation, seamless patient care and 

6 navigation, palliative care, and care provided to un7 derserved populations. 

8 (b) REPORTS.—

9 (1) IN GENERAL.—Not later than 4 years after 

10 the date of enactment of this Act, the Institute of 

11 Medicine shall submit to the Secretary of Health 

12 and Human Services a report containing information 

13 on the evaluation conducted under paragraphs (1) 

14 through (5) of subsection (a), including data col15 lected at the State level through contracts with ap16 propriate organizations as designated by the Insti17 tute of Medicine. 

18 (2) 8 YEARS.—Not later than 8 years after the 

19 date of enactment of this Act, the Institute of Medi20 cine shall submit to the Secretary of Health and 

21 Human Services a report containing information and 

22 recommendations on the areas described in sub23 section (a), including data collected from relevant 

24 demonstration projects. 
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1 (3) REPORTS.—The Secretary of Health and 

2 Human Services shall submit the reports described 

3 in paragraphs (1) and (2) to the relevant committees 

4 of Congress. 

5 (c) DEFINITIONS.—

6 (1) PALLIATIVE CARE; QUALITY OF CANCER

7 CARE.—The terms ‘palliative care’ and ‘quality of 

8 cancer care’ have the meanings given such terms in 

9 section 399AA of the Public Health Service Act. 

10 (2) COMPREHENSIVE CANCER CONTROL PRO11 GRAM.—The term ‘comprehensive cancer control 

12 program’ has the meaning given such term in sec13 tion 320B of the Public Health Service Act. 

14 (3) HEALTH DISPARITY POPULATION AND

15 HEALTH DISPARITIES RESEARCH.—The terms 

16 ‘‘health disparity population’’ and ‘‘health disparities 

17 research’’ have the meanings given such terms in 

18 section 399AA of the Public Health Service Act. 

19 (d) AUTHORIZATION OF APPROPRIATIONS.—There is 

20 authorized to be appropriated to carry out this section, 

21 such sums as may be necessary for each of fiscal years 

22 2006 through 2010.

Æ