I 

108TH CONGRESS 

2D SESSION H. R. 4093 

To amend the Public Health Service Act to establish a program of grants 

for the detection and control of colorectal cancer. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 31, 2004 

Mr. KENNEDY of Rhode Island 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 program of grants for the detection and control of colorectal 

cancer. 

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 Mor5 tality Prevention Act of 2004’’. 
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1 SEC. 2. ESTABLISHMENT OF PROGRAM OF GRANTS TO 

2 STATES FOR DETECTION AND CONTROL OF 

3 COLORECTAL CANCER. 

4 The Public Health Service Act (42 U.S.C. 201 et 

5 seq.) is amended by inserting after title XXVIII the fol6 lowing new title: 

7 ‘‘TITLE XXIX—PREVENTIVE 

8 HEALTH MEASURES WITH RE9 SPECT TO COLORECTAL CAN10 CERS 

11 ‘‘SEC. 2901. ESTABLISHMENT OF PROGRAM OF GRANTS TO 

12 STATES. 

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

14 the Director of the Centers for Disease Control and Pre15 vention, may make grants to States on the basis of an 

16 established competitive review process for the purpose of 

17 carrying out programs— 

18 ‘‘(1) to screen for colorectal cancer as a preven19 tive health measure; 

20 ‘‘(2) to provide appropriate referrals for medical 

21 treatment of individuals screened pursuant to para22 graph (1) and to ensure, to the extent practicable, 

23 the provision of appropriate follow-up services; 

24 ‘‘(3) to develop and disseminate public informa25 tion and education programs for the detection and 

26 control of colorectal cancer; 
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1 ‘‘(4) to improve the education, training, and 

2 skills of health professionals (including allied health 

3 professionals) in the detection and control of 

4 colorectal cancer; 

5 ‘‘(5) to establish mechanisms through which the 

6 States can monitor the quality of screening proce7 dures for colorectal cancer, including the interpreta8 tion of such procedures; and 

9 ‘‘(6) to evaluate activities conducted under 

10 paragraphs (1) through (5) through appropriate sur11 veillance or program-monitoring activities. 

12 ‘‘(b) GRANT AND CONTRACT AUTHORITY OF

13 STATES.—A State receiving a grant under subsection (a) 

14 may expend the grant to carry out the purpose described 

15 in such subsection through grants to, and contracts with, 

16 public or nonprofit private entities. 

17 ‘‘SEC. 2902. REQUIREMENT OF MATCHING FUNDS. 

18 ‘‘(a) IN GENERAL.—The Secretary may not make a 

19 grant under section 2901 unless the State involved agrees, 

20 with respect to the costs to be incurred by the State in 

21 carrying out the purpose described in such section, to 

22 make available non-Federal contributions (in cash or in 

23 kind under subsection (b)) toward such costs in an amount 

24 that is not less than $1 for each $3 of Federal funds pro-
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1 vided in the grant. Such contributions may be made di2 rectly or through donations from public or private entities. 

3 ‘‘(b) DETERMINATION OF AMOUNT OF NON-FED4 ERAL CONTRIBUTION.— 

5 ‘‘(1) IN GENERAL.—Non-Federal contributions 

6 required in subsection (a) may be in cash or in kind, 

7 fairly evaluated, including equipment or services 

8 (and excluding indirect or overhead costs). Amounts 

9 provided by the Federal Government, or services as10 sisted or subsidized to any significant extent by the 

11 Federal Government, may not be included in deter12 mining the amount of such non-Federal contribu13 tions. 

14 ‘‘(2) MAINTENANCE OF EFFORT.—In making a 

15 determination of the amount of non-Federal con16 tributions for purposes of subsection (a), the Sec17 retary may include only non-Federal contributions in 

18 excess of the average amount of non-Federal con19 tributions made by the State involved toward the 

20 purpose described in section 2901 for the 2-year pe21 riod preceding the first fiscal year for which the 

22 State is applying to receive a grant under such sec23 tion. 

24 ‘‘(3) INCLUSION OF RELEVANT NON-FEDERAL

25 CONTRIBUTIONS FOR MEDICAID.—In making a de-
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1 termination of the amount of non-Federal contribu2 tions for purposes of subsection (a), the Secretary 

3 shall, subject to paragraphs (1) and (2) of this sub4 section, include any non-Federal amounts expended 

5 pursuant to title XIX of the Social Security Act by 

6 the State involved toward the purpose described in 

7 paragraphs (1) and (2) of section 2901(a). 

8 ‘‘SEC. 2903. REQUIREMENTS WITH RESPECT TO TYPE AND 

9 QUALITY OF SERVICES. 

10 ‘‘(a) REQUIREMENT OF PROVISION OF ALL SERVICES

11 BY DATE CERTAIN.—The Secretary may not make a 

12 grant under section 2901 unless the State involved 

13 agrees— 

14 ‘‘(1) to ensure that, initially and throughout the 

15 period during which amounts are received pursuant 

16 to the grant, not less than 60 percent of the grant 

17 is expended to provide each of the services or activi18 ties described in paragraphs (1) and (2) of section 

19 2901(a), including making available screening proce20 dures for colorectal cancer; 

21 ‘‘(2) to ensure that, by the end of any second 

22 fiscal year of payments pursuant to the grant, each 

23 of the services or activities described in section 

24 2901(a) is provided; and 
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1 ‘‘(3) to ensure that not more than 40 percent 

2 of the grant is expended to provide the services or 

3 activities described in paragraphs (3) through (6) of 

4 such section. 

5 ‘‘(b) QUALITY ASSURANCE REGARDING SCREENING

6 FOR COLORECTAL CANCER.—The Secretary may not 

7 make a grant under section 2901 unless the State in8 volved— 

9 ‘‘(1) assures the quality of any screening proce10 dure for colorectal cancer conducted pursuant to 

11 such section; and 

12 ‘‘(2) assures that, with respect to the first 

13 colorectal cancer screening performed on an indi14 vidual for which payment is made pursuant to sec15 tion 2901(a), there are satisfactory assurances that 

16 the results of the screening will be placed in perma17 nent medical records maintained with respect to the 

18 individual. 

19 ‘‘(c) ISSUANCE BY SECRETARY OF GUIDELINES

20 WITH RESPECT TO QUALITY OF COLORECTAL SERV21 ICES.— 

22 ‘‘(1) IN GENERAL.—The Secretary shall issue 

23 guidelines for assuring the quality of any colorectal 

24 screening procedure conducted pursuant to section 

25 2901(a). 
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1 ‘‘(2) APPLICABILITY WITH RESPECT TO

2 GRANTS.—The Secretary may not make a grant 

3 under section 2901 unless the State involved agrees 

4 that the State will, with respect to any colorectal 

5 screening procedure conducted pursuant to such sec6 tion, ensure that the procedure is conducted in ac7 cordance with the guidelines issued by the Secretary 

8 under paragraph (1). 

9 ‘‘SEC. 2904. ADDITIONAL REQUIRED AGREEMENTS. 

10 ‘‘(a) PRIORITY FOR LOW-INCOME INDIVIDUALS.— 

11 The Secretary may not make a grant under section 2901 

12 unless the State involved agrees that low-income individ13 uals will be given priority in the provision of services and 

14 activities pursuant to paragraphs (1) and (2) of section 

15 2901(a). 

16 ‘‘(b) LIMITATION ON IMPOSITION OF FEES FOR

17 SERVICES.—The Secretary may not make a grant under 

18 section 2901 unless the State involved agrees that, if a 

19 charge is imposed for the provision of services or activities 

20 under the grant, such charge— 

21 ‘‘(1) will be made according to a schedule of 

22 charges that is made available to the public; 

23 ‘‘(2) will be adjusted to reflect the income of 

24 the individuals involved; and 
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1 ‘‘(3) will not be imposed on any individual with 

2 an income of less than 100 percent of the official 

3 poverty line, as established by the Director of the 

4 Office of Management and Budget and revised by 

5 the Secretary in accordance with section 673(2) of 

6 the Omnibus Budget Reconciliation Act of 1981. 

7 ‘‘(c) STATEWIDE PROVISION OF SERVICES.— 

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

9 make a grant under section 2901 unless the State 

10 involved agrees that services and activities under the 

11 grant will be made available throughout the State, 

12 including availability to members of any Indian tribe 

13 or tribal organization (as such terms are defined in 

14 section 4 of the Indian Self-Determination and Edu15 cation Assistance Act). 

16 ‘‘(2) WAIVER.—The Secretary may waive the 

17 requirement established in paragraph (1) for a State 

18 if the Secretary determines that compliance by the 

19 State with the requirement would result in an ineffi20 cient allocation of resources with respect to carrying 

21 out the purpose described in section 2901(a). 

22 ‘‘(d) RELATIONSHIP TO ITEMS AND SERVICES

23 UNDER OTHER PROGRAMS.—The Secretary may not 

24 make a grant under section 2901 unless the State involved 

25 agrees that the grant will not be expended to make pay-
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1 ment for any item or service to the extent that payment 

2 has been made, or can reasonably be expected to be made, 

3 with respect to such item or service— 

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

5 under an insurance policy, or under any Federal or 

6 State health benefits program; or 

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

8 on a prepaid basis. 

9 ‘‘(e) COORDINATION WITH OTHER COLORECTAL

10 CANCER PROGRAMS.—The Secretary may not make a 

11 grant under section 2901 unless the State involved agrees 

12 that the services and activities funded through the grant 

13 will be coordinated with other Federal, State, and local 

14 colorectal cancer programs. 

15 ‘‘(f) LIMITATION ON ADMINISTRATIVE EXPENSES.— 

16 The Secretary may not make a grant under section 2901 

17 unless the State involved agrees that not more than 10 

18 percent of the grant will be expended for administrative 

19 expenses with respect to the grant. 

20 ‘‘(g) RESTRICTIONS ON USE OF GRANT.—The Sec21 retary may not make a grant under section 2901 unless 

22 the State involved agrees that the grant will not be ex23 pended to provide inpatient hospital services (as that term 

24 is defined by the Secretary for purposes of this sub25 section). 
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1 ‘‘(h) RECORDS AND AUDITS.—The Secretary may not 

2 make a grant under section 2901 unless the State involved 

3 agrees that— 

4 ‘‘(1) the State will establish such fiscal control 

5 and fund accounting procedures as may be necessary 

6 to ensure the proper disbursement of, and account7 ing for, amounts received by the State under such 

8 section; and 

9 ‘‘(2) upon request, the State will provide 

10 records maintained pursuant to paragraph (1) to the 

11 Secretary or the Comptroller General of the United 

12 States for purposes of auditing the expenditures by 

13 the State of the grant. 

14 ‘‘(i) REPORTS TO SECRETARY.—The Secretary may 

15 not make a grant under section 2901 unless the State in16 volved agrees to submit to the Secretary such reports as 

17 the Secretary may require with respect to the grant. 

18 ‘‘SEC. 2905. DESCRIPTION OF INTENDED USES OF GRANT. 

19 ‘‘The Secretary may not make a grant under section 

20 2901 unless— 

21 ‘‘(1) the State involved submits to the Secretary 

22 a description of the purposes for which the State in23 tends to expend the grant; 
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1 ‘‘(2) the description identifies the populations, 

2 areas, and localities in the State with a need for the 

3 services or activities described in section 2901(a); 

4 ‘‘(3) the description provides information relat5 ing to the services and activities to be provided, in6 cluding a description of the manner in which the 

7 services and activities will be coordinated with any 

8 similar services or activities of public or nonprofit 

9 entities; and 

10 ‘‘(4) the description provides assurances that 

11 the grant funds be used in the most cost-effective 

12 manner. 

13 ‘‘SEC. 2906. REQUIREMENT OF SUBMISSION OF APPLICA14 TION. 

15 ‘‘The Secretary may not make a grant under section 

16 2901 unless an application for the grant is submitted to 

17 the Secretary, the application contains the description of 

18 intended uses required in section 2905, and the applica19 tion is in such form, is made in such manner, and contains 

20 such agreements, assurances, and information as the Sec21 retary determines to be necessary to carry out this title. 
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1 ‘‘SEC. 2907. TECHNICAL ASSISTANCE AND PROVISION OF 

2 SUPPLIES AND SERVICES IN LIEU OF GRANT 

3 FUNDS. 

4 ‘‘(a) TECHNICAL ASSISTANCE.—The Secretary may 

5 provide training and technical assistance with respect to 

6 the planning, development, and operation of any program 

7 or service carried out pursuant to section 2901. The Sec8 retary may provide such technical assistance directly or 

9 through grants to, or contracts with, public and private 

10 entities. 

11 ‘‘(b) PROVISION OF SUPPLIES AND SERVICES IN

12 LIEU OF GRANT FUNDS.— 

13 ‘‘(1) IN GENERAL.—Upon the request of a 

14 State receiving a grant under section 2901, the Sec15 retary may, subject to paragraph (2), provide sup16 plies, equipment, and services for the purpose of aid17 ing the State in carrying out such section and, for 

18 such purpose, may detail to the State any officer or 

19 employee of the Department of Health and Human 

20 Services. 

21 ‘‘(2) CORRESPONDING REDUCTION IN PAY22 MENTS.—With respect to a request described in 

23 paragraph (1), the Secretary shall reduce the 

24 amount of payments under the grant under section 

25 2901 to the State involved by an amount equal to 

26 the costs of detailing personnel (including pay, al-
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1 lowances, and travel expenses) and the fair market 

2 value of any supplies, equipment, or services pro3 vided by the Secretary. The Secretary shall, for the 

4 payment of expenses incurred in complying with 

5 such request, expend the amounts withheld. 

6 ‘‘SEC. 2908. EVALUATIONS AND REPORTS. 

7 ‘‘(a) EVALUATIONS.—The Secretary shall, directly or 

8 through contracts with public or private entities, provide 

9 for annual evaluations of programs carried out pursuant 

10 to section 2901. 

11 ‘‘(b) REPORT TO CONGRESS.—The Secretary shall, 

12 not later than 1 year after the date on which amounts 

13 are first appropriated to carry out section 2909(a), and 

14 annually thereafter, submit to the appropriate congres15 sional committees a report summarizing evaluations car16 ried out pursuant to subsection (a) during the preceding 

17 fiscal year and making such recommendations for admin18 istrative and legislative initiatives with respect to this title 

19 as the Secretary determines to be appropriate. 

20 ‘‘SEC. 2909. FUNDING. 

21 ‘‘(a) AUTHORIZATION OF APPROPRIATIONS.—For the 

22 purpose of carrying out this title, there is authorized to 

23 be appropriated $25,000,000 for each of the fiscal years 

24 2005 through 2008. 
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1 ‘‘(b) SET-ASIDE FOR TECHNICAL ASSISTANCE AND

2 PROVISION OF SUPPLIES AND SERVICES.—Of the 

3 amounts appropriated under subsection (a) for a fiscal 

4 year, the Secretary shall reserve not more than 10 percent 

5 for carrying out section 2907.’’. 

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