II 

Calendar No. 115 

109TH CONGRESS 

1ST SESSION S. 898 

[Report No. 109–73] 

To amend the Public Health Service Act to authorize a demonstration grant 

program to provide patient navigator services to reduce barriers and 

improve health care outcomes, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

APRIL 25, 2005 

Mrs. HUTCHISON (for herself, Mr. BINGAMAN, Mr. BROWNBACK, Mr. KENNEDY, and Mr. COCHRAN) introduced the following bill; which was read 

twice and referred to the Committee on Health, Education, Labor, and 

Pensions 

MAY 25, 2005 

Reported by Mr. ENZI, with an amendment 

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

A BILL

To amend the Public Health Service Act to authorize a 

demonstration grant program to provide patient navigator services to reduce barriers and improve health care 

outcomes, 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,
2

•S 898 RS

1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Patient Navigator Out3 reach and Chronic Disease Prevention Act of 2005’’. 

4 SEC. 2. PATIENT NAVIGATOR GRANTS. 

5 Subpart V of part D of title III of the Public Health 

6 Service Act (42 U.S.C. 256) is amended by adding at the 

7 end the following: 

8 ‘‘SEC. 340A. PATIENT NAVIGATOR GRANTS. 

9 ‘‘(a) GRANTS.—The Secretary, acting through the 

10 Administrator of the Health Resources and Services Ad11 ministration, may make grants to eligible entities for the 

12 development and operation of demonstration programs to 

13 provide patient navigator services to improve health care 

14 outcomes. The Secretary shall coordinate with, and ensure 

15 the participation of, the Indian Health Service, the Na16 tional Cancer Institute, the Office of Rural Health Policy, 

17 and such other offices and agencies as deemed appropriate 

18 by the Secretary, regarding the design and evaluation of 

19 the demonstration programs. 

20 ‘‘(b) USE OF FUNDS.—The Secretary shall require 

21 each recipient of a grant under this section to use the 

22 grant to recruit, assign, train, and employ patient naviga23 tors who have direct knowledge of the communities they 

24 serve to facilitate the care of individuals, including by per25 forming each of the following duties: 
3

•S 898 RS

1 ‘‘(1) Acting as contacts, including by assisting 

2 in the coordination of health care services and pro3 vider referrals, for individuals who are seeking pre4 vention or early detection services for, or who fol5 lowing a screening or early detection service are 

6 found to have a symptom, abnormal finding, or diag7 nosis of, cancer or other chronic disease. 

8 ‘‘(2) Facilitating the involvement of community 

9 organizations in assisting individuals who are at risk 

10 for or who have cancer or other chronic diseases to 

11 receive better access to high-quality health care serv12 ices (such as by creating partnerships with patient 

13 advocacy groups, charities, health care centers, com14 munity hospice centers, other health care providers, 

15 or other organizations in the targeted community). 

16 ‘‘(3) Notifying individuals of clinical trials and, 

17 on request, facilitating enrollment of eligible individ18 uals in these trials. 

19 ‘‘(4) Anticipating, identifying, and helping pa20 tients to overcome barriers within the health care 

21 system to ensure prompt diagnostic and treatment 

22 resolution of an abnormal finding of cancer or other 

23 chronic disease. 

24 ‘‘(5) Coordinating with the relevant health in25 surance ombudsman programs to provide informa-
4

•S 898 RS

1 tion to individuals who are at risk for or who have 

2 cancer or other chronic diseases about health cov3 erage, including private insurance, health care sav4 ings accounts, and other publicly funded programs 

5 (such as Medicare, Medicaid, health programs oper6 ated by the Department of Veterans Affairs or the 

7 Department of Defense, the State children’s health 

8 insurance program, and any private or governmental 

9 prescription assistance programs). 

10 ‘‘(6) Conducting ongoing outreach to health dis11 parity populations, including the uninsured, rural 

12 populations, and other medically underserved popu13 lations, in addition to assisting other individuals who 

14 are at risk for or who have cancer or other chronic 

15 diseases to seek preventative care. 

16 ‘‘(c) PROHIBITIONS.— 

17 ‘‘(1) REFERRAL FEES.—The Secretary shall re18 quire each recipient of a grant under this section to 

19 prohibit any patient navigator providing services 

20 under the grant from accepting any referral fee, 

21 kickback, or other thing of value in return for refer22 ring an individual to a particular health care pro23 vider. 

24 ‘‘(2) LEGAL FEES AND COSTS.—The Secretary 

25 shall prohibit the use of any grant funds received 
5

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1 under this section to pay any fees or costs resulting 

2 from any litigation, arbitration, mediation, or other 

3 proceeding to resolve a legal dispute. 

4 ‘‘(d) GRANT PERIOD.— 

5 ‘‘(1) IN GENERAL.—Subject to paragraphs (2) 

6 and (3), the Secretary may award grants under this 

7 section for periods of not more than 3 years. 

8 ‘‘(2) EXTENSIONS.—Subject to paragraph (3), 

9 the Secretary may extend the period of a grant 

10 under this section. Each such extension shall be for 

11 a period of not more than 1 year. 

12 ‘‘(3) LIMITATIONS ON GRANT PERIOD.—In car13 rying out this section, the Secretary— 

14 ‘‘(A) shall ensure that the total period of 

15 a grant does not exceed 4 years; and 

16 ‘‘(B) may not authorize any grant period 

17 ending after September 30, 2010. 

18 ‘‘(e) APPLICATION.— 

19 ‘‘(1) IN GENERAL.—To seek a grant under this 

20 section, an eligible entity shall submit an application 

21 to the Secretary in such form, in such manner, and 

22 containing such information as the Secretary may 

23 require. 

24 ‘‘(2) CONTENTS.—At a minimum, the Secretary 

25 shall require each such application to outline how 
6

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1 the eligible entity will establish baseline measures 

2 and benchmarks that meet the Secretary’s require3 ments to evaluate program outcomes. 

4 ‘‘(f) UNIFORM BASELINE MEASURES.—The Sec5 retary shall establish uniform baseline measures in order 

6 to properly evaluate the impact of the demonstration 

7 projects under this section. 

8 ‘‘(g) PREFERENCE.—In making grants under this 

9 section, the Secretary shall give preference to eligible enti10 ties that demonstrate in their applications plans to utilize 

11 patient navigator services to overcome significant barriers 

12 in order to improve health care outcomes in their respec13 tive communities. 

14 ‘‘(h) DUPLICATION OF SERVICES.—An eligible entity 

15 that is receiving Federal funds for activities described in 

16 subsection (b) on the date on which the entity submits 

17 an application under subsection (e), may not receive a 

18 grant under this section unless the entity can demonstrate 

19 that amounts received under the grant will be utilized to 

20 expand services or provide new services to individuals who 

21 would not otherwise be served. 

22 ‘‘(i) COORDINATION WITH OTHER PROGRAMS.—The 

23 Secretary shall ensure coordination of the demonstration 

24 grant program under this section with existing authorized 
7

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1 programs in order to facilitate access to high-quality 

2 health care services. 

3 ‘‘(j) STUDY; REPORTS.— 

4 ‘‘(1) FINAL REPORT BY SECRETARY.—Not later 

5 than 6 months after the completion of the dem6 onstration grant program under this section, the 

7 Secretary shall conduct a study of the results of the 

8 program and submit to the Congress a report on 

9 such results that includes the following: 

10 ‘‘(A) An evaluation of the program out11 comes, including— 

12 ‘‘(i) quantitative analysis of baseline 

13 and benchmark measures; and 

14 ‘‘(ii) aggregate information about the 

15 patients served and program activities. 

16 ‘‘(B) Recommendations on whether patient 

17 navigator programs could be used to improve 

18 patient outcomes in other public health areas. 

19 ‘‘(2) REPORTS BY SECRETARY.—The Secretary 

20 may provide interim reports to the Congress on the 

21 demonstration grant program under this section at 

22 such intervals as the Secretary determines to be ap23 propriate. 

24 ‘‘(3) INTERIM REPORTS BY GRANTEES.—The 

25 Secretary may require grant recipients under this 
8

•S 898 RS

1 section to submit interim and final reports on grant 

2 program outcomes. 

3 ‘‘(k) RULE OF CONSTRUCTION.—This section shall 

4 not be construed to authorize funding for the delivery of 

5 health care services (other than the patient navigator du6 ties listed in subsection (b)). 

7 ‘‘(l) DEFINITIONS.—In this section: 

8 ‘‘(1) The term ‘eligible entity’ means a public 

9 or nonprofit private health center (including a Fed10 erally qualified health center (as that term is defined 

11 in section 1861(aa)(4) of the Social Security Act)), 

12 a health facility operated by or pursuant to a con13 tract with the Indian Health Service, a hospital, a 

14 cancer center, a rural health clinic, an academic 

15 health center, or a nonprofit entity that enters into 

16 a partnership or coordinates referrals with such a 

17 center, clinic, facility, or hospital to provide patient 

18 navigator services. 

19 ‘‘(2) The term ‘health disparity population’ 

20 means a population that, as determined by the Sec21 retary, has a significant disparity in the overall rate 

22 of disease incidence, prevalence, morbidity, mor23 tality, or survival rates as compared to the health 

24 status of the general population. 
9

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1 ‘‘(3) The term ‘patient navigator’ means an in2 dividual who has completed a training program ap3 proved by the Secretary to perform the duties listed 

4 in subsection (b). 

5 ‘‘(m) AUTHORIZATION OF APPROPRIATIONS.— 

6 ‘‘(1) IN GENERAL.—To carry out this section, 

7 there are authorized to be appropriated $2,000,000 

8 for fiscal year 2006, $5,000,000 for fiscal year 

9 2007, $8,000,000 for fiscal year 2008, $6,500,000 

10 for fiscal year 2009, and $3,500,000 for fiscal year 

11 2010. 

12 ‘‘(2) AVAILABILITY.—The amounts appro13 priated pursuant to paragraph (1) shall remain 

14 available for obligation through the end of fiscal year 

15 2010.’’.

16 SECTION 1. SHORT TITLE. 

17 This Act may be cited as the ‘‘Patient Navigator Out18 reach and Chronic Disease Prevention Act of 2005’’. 

19 SEC. 2. PATIENT NAVIGATOR GRANTS. 

20 Subpart V of part D of title III of the Public Health 

21 Service Act (42 U.S.C. 256) is amended by adding at the 

22 end the following: 

23 ‘‘SEC. 340A. PATIENT NAVIGATOR GRANTS. 

24 ‘‘(a) GRANTS.—The Secretary, acting through the Ad25 ministrator of the Health Resources and Services Adminis-
10

•S 898 RS

1 tration, may make grants to eligible entities for the develop2 ment and operation of demonstration programs to provide 

3 patient navigator services to improve health care outcomes. 

4 The Secretary shall coordinate with, and ensure the partici5 pation of, the Indian Health Service, the National Cancer 

6 Institute, the Office of Rural Health Policy, and such other 

7 offices and agencies as deemed appropriate by the Sec8 retary, regarding the design and evaluation of the dem9 onstration programs. 

10 ‘‘(b) USE OF FUNDS.—The Secretary shall require 

11 each recipient of a grant under this section to use the grant 

12 to recruit, assign, train, and employ patient navigators 

13 who have direct knowledge of the communities they serve 

14 to facilitate the care of individuals, including by per15 forming each of the following duties: 

16 ‘‘(1) Acting as contacts, including by assisting 

17 in the coordination of health care services and pro18 vider referrals, for individuals who are seeking pre19 vention or early detection services for, or who fol20 lowing a screening or early detection service are 

21 found to have a symptom, abnormal finding, or diag22 nosis of, cancer or other chronic disease. 

23 ‘‘(2) Facilitating the involvement of community 

24 organizations in assisting individuals who are at risk 

25 for or who have cancer or other chronic diseases to re-
11

•S 898 RS

1 ceive better access to high-quality health care services 

2 (such as by creating partnerships with patient advo3 cacy groups, charities, health care centers, community 

4 hospice centers, other health care providers, or other 

5 organizations in the targeted community). 

6 ‘‘(3) Notifying individuals of clinical trials and, 

7 on request, facilitating enrollment of eligible individ8 uals in these trials. 

9 ‘‘(4) Anticipating, identifying, and helping pa10 tients to overcome barriers within the health care sys11 tem to ensure prompt diagnostic and treatment reso12 lution of an abnormal finding of cancer or other 

13 chronic disease. 

14 ‘‘(5) Coordinating with the relevant health insur15 ance ombudsman programs to provide information to 

16 individuals who are at risk for or who have cancer 

17 or other chronic diseases about health coverage, in18 cluding private insurance, health care savings ac19 counts, and other publicly funded programs (such as 

20 Medicare, Medicaid, health programs operated by the 

21 Department of Veterans Affairs or the Department of 

22 Defense, the State children’s health insurance pro23 gram, and any private or governmental prescription 

24 assistance programs). 
12

•S 898 RS

1 ‘‘(6) Conducting ongoing outreach to health dis2 parity populations, including the uninsured, rural 

3 populations, and other medically underserved popu4 lations, in addition to assisting other individuals who 

5 are at risk for or who have cancer or other chronic 

6 diseases to seek preventative care. 

7 ‘‘(c) PROHIBITIONS.— 

8 ‘‘(1) REFERRAL FEES.—The Secretary shall re9 quire each recipient of a grant under this section to 

10 prohibit any patient navigator providing services 

11 under the grant from accepting any referral fee, kick12 back, or other thing of value in return for referring 

13 an individual to a particular health care provider. 

14 ‘‘(2) LEGAL FEES AND COSTS.—The Secretary 

15 shall prohibit the use of any grant funds received 

16 under this section to pay any fees or costs resulting 

17 from any litigation, arbitration, mediation, or other 

18 proceeding to resolve a legal dispute. 

19 ‘‘(d) GRANT PERIOD.— 

20 ‘‘(1) IN GENERAL.—Subject to paragraphs (2) 

21 and (3), the Secretary may award grants under this 

22 section for periods of not more than 3 years. 

23 ‘‘(2) EXTENSIONS.—Subject to paragraph (3), 

24 the Secretary may extend the period of a grant under 
13

•S 898 RS

1 this section. Each such extension shall be for a period 

2 of not more than 1 year. 

3 ‘‘(3) LIMITATIONS ON GRANT PERIOD.—In car4 rying out this section, the Secretary— 

5 ‘‘(A) shall ensure that the total period of a 

6 grant does not exceed 4 years; and 

7 ‘‘(B) may not authorize any grant period 

8 ending after September 30, 2010. 

9 ‘‘(e) APPLICATION.— 

10 ‘‘(1) IN GENERAL.—To seek a grant under this 

11 section, an eligible entity shall submit an application 

12 to the Secretary in such form, in such manner, and 

13 containing such information as the Secretary may re14 quire. 

15 ‘‘(2) CONTENTS.—At a minimum, the Secretary 

16 shall require each such application to outline how the 

17 eligible entity will establish baseline measures and 

18 benchmarks that meet the Secretary’s requirements to 

19 evaluate program outcomes. 

20 ‘‘(f) UNIFORM BASELINE MEASURES.—The Secretary 

21 shall establish uniform baseline measures in order to prop22 erly evaluate the impact of the demonstration projects under 

23 this section. 

24 ‘‘(g) PREFERENCE.—In making grants under this sec25 tion, the Secretary shall give preference to eligible entities 
14

•S 898 RS

1 that demonstrate in their applications plans to utilize pa2 tient navigator services to overcome significant barriers in 

3 order to improve health care outcomes in their respective 

4 communities. 

5 ‘‘(h) DUPLICATION OF SERVICES.—An eligible entity 

6 that is receiving Federal funds for activities described in 

7 subsection (b) on the date on which the entity submits an 

8 application under subsection (e), may not receive a grant 

9 under this section unless the entity can demonstrate that 

10 amounts received under the grant will be utilized to expand 

11 services or provide new services to individuals who would 

12 not otherwise be served. 

13 ‘‘(i) COORDINATION WITH OTHER PROGRAMS.—The 

14 Secretary shall ensure coordination of the demonstration 

15 grant program under this section with existing authorized 

16 programs in order to facilitate access to high-quality health 

17 care services. 

18 ‘‘(j) STUDY; REPORTS.— 

19 ‘‘(1) FINAL REPORT BY SECRETARY.—Not later 

20 than 180 days after the completion of the demonstra21 tion grant program under this section, the Secretary 

22 shall conduct a study of the results of the program 

23 and submit to the Congress a report on such results 

24 that includes the following: 
15

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1 ‘‘(A) An evaluation of the program out2 comes, including— 

3 ‘‘(i) quantitative analysis of baseline 

4 and benchmark measures; and 

5 ‘‘(ii) aggregate information about the 

6 patients served and program activities. 

7 ‘‘(B) Recommendations on whether patient 

8 navigator programs could be used to improve pa9 tient outcomes in other public health areas. 

10 ‘‘(2) REPORTS BY SECRETARY.—The Secretary 

11 may provide interim reports to the Congress on the 

12 demonstration grant program under this section at 

13 such intervals as the Secretary determines to be ap14 propriate. 

15 ‘‘(3) INTERIM REPORTS BY GRANTEES.—The Sec16 retary may require grant recipients under this section 

17 to submit interim and final reports on grant program 

18 outcomes. 

19 ‘‘(k) RULE OF CONSTRUCTION.—This section shall not 

20 be construed to authorize funding for the delivery of health 

21 care services (other than the patient navigator duties listed 

22 in subsection (b)). 

23 ‘‘(l) DEFINITIONS.—In this section: 

24 ‘‘(1) The term ‘eligible entity’ means a public or 

25 nonprofit private health center (including a Federally 
16

•S 898 RS

1 qualified health center (as that term is defined in sec2 tion 1861(aa)(4) of the Social Security Act)), a health 

3 facility operated by or pursuant to a contract with 

4 the Indian Health Service, a hospital, a cancer cen5 ter, a rural health clinic, an academic health center, 

6 or a nonprofit entity that enters into a partnership 

7 or coordinates referrals with such a center, clinic, fa8 cility, or hospital to provide patient navigator serv9 ices. 

10 ‘‘(2) The term ‘health disparity population’ 

11 means a population that, as determined by the Sec12 retary, has a significant disparity in the overall rate 

13 of disease incidence, prevalence, morbidity, mortality, 

14 or survival rates as compared to the health status of 

15 the general population. 

16 ‘‘(3) The term ‘patient navigator’ means an in17 dividual who has completed a training program ap18 proved by the Secretary to perform the duties listed 

19 in subsection (b). 

20 ‘‘(m) AUTHORIZATION OF APPROPRIATIONS.— 

21 ‘‘(1) IN GENERAL.—To carry out this section, 

22 there are authorized to be appropriated $2,000,000 for 

23 fiscal year 2006, $5,000,000 for fiscal year 2007, 

24 $8,000,000 for fiscal year 2008, $6,500,000 for fiscal 

25 year 2009, and $3,500,000 for fiscal year 2010. 
17

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1 ‘‘(2) AVAILABILITY.—The amounts appropriated 

2 pursuant to paragraph (1) shall remain available for 

3 obligation through the end of fiscal year 2010.’’. 
Calendar No. 115 

109TH CONGRESS 

1ST SESSION S. 898 

[Report No. 109–73] 

A BILL

To amend the Public Health Service Act to authorposes. improve health care outcomes, and for other pur- tient navigator services to reduce barriers and ize a demonstration grant program to provide paMAY 25, 2005 

Reported with an amendment