II 

108TH CONGRESS 

2D SESSION H. R. 918 

IN THE SENATE OF THE UNITED STATES 

OCTOBER 6, 2004 

Received 

AN ACT 

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, 
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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Patient Navigator Out3 reach and Chronic Disease Prevention Act of 2004’’. 

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.—A condition on the receipt of 

21 a grant under this section is that the grantee agree to 

22 use the grant to recruit, assign, train, and employ patient 

23 navigators who have direct knowledge of the communities 

24 they serve to facilitate the care of individuals, including 

25 by performing each of the following duties: 
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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 providing assistance to individuals who 

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

11 diseases to receive better access to high-quality 

12 health care services (such as by creating partner13 ships with patient advocacy groups, charities, health 

14 care centers, community hospice centers, other 

15 health care providers, or other organizations in the 

16 targeted community). 

17 ‘‘(3) Notifying individuals of clinical trials and 

18 facilitating enrollment in these trials if requested 

19 and eligible. 

20 ‘‘(4) Anticipating, identifying, and helping pa21 tients to overcome barriers within the health care 

22 system to ensure prompt diagnostic and treatment 

23 resolution of an abnormal finding of cancer or other 

24 chronic disease. 
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1 ‘‘(5) Coordinating with the relevant health in2 surance ombudsman programs to provide informa3 tion to individuals who are at risk for or who have 

4 cancer or other chronic diseases about health cov5 erage, including private insurance, health care sav6 ings accounts, and other publicly funded programs 

7 (such as Medicare, Medicaid, and the State chil8 dren’s health insurance program). 

9 ‘‘(6) Conducting ongoing outreach to health dis10 parity populations, including the uninsured, rural 

11 populations, and other medically underserved popu12 lations, in addition to assisting other individuals who 

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

14 diseases to seek preventative care. 

15 ‘‘(c) GRANT PERIOD.— 

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

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

18 section for periods of not more than 3 years. 

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

20 the Secretary may extend the period of a grant 

21 under this section, except that— 

22 ‘‘(A) each such extension shall be for a pe23 riod of not more than 1 year; and 
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1 ‘‘(B) the Secretary may make not more 

2 than 4 such extensions with respect to any 

3 grant. 

4 ‘‘(3) END OF GRANT PERIOD.—In carrying out 

5 this section, the Secretary may not authorize any 

6 grant period ending after September 30, 2010. 

7 ‘‘(d) APPLICATION.— 

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

9 section, an eligible entity shall submit an application 

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

11 containing such information as the Secretary may 

12 require. 

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

14 shall require each such application to outline how 

15 the eligible entity will establish baseline measures 

16 and benchmarks that meet the Secretary’s require17 ments to evaluate program outcomes. 

18 ‘‘(e) UNIFORM BASELINE MEASURES.—The Sec19 retary shall establish uniform baseline measures in order 

20 to properly evaluate the impact of the demonstration 

21 projects under this section. 

22 ‘‘(f) PREFERENCE.—In making grants under this 

23 section, the Secretary shall give preference to eligible enti24 ties that demonstrate in their applications plans to utilize 

25 patient navigator services to overcome significant barriers 
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1 in order to improve health care outcomes in their respec2 tive communities. 

3 ‘‘(g) COORDINATION WITH OTHER PROGRAMS.—The 

4 Secretary shall ensure coordination of the demonstration 

5 grant program under this section with existing authorized 

6 programs in order to facilitate access to high-quality 

7 health care services. 

8 ‘‘(h) STUDY; REPORTS.— 

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

10 than 6 months after the completion of the dem11 onstration grant program under this section, the 

12 Secretary shall conduct a study of the results of the 

13 program and submit to the Congress a report on 

14 such results that includes the following: 

15 ‘‘(A) An evaluation of the program out16 comes, including— 

17 ‘‘(i) quantitative analysis of baseline 

18 and benchmark measures; and 

19 ‘‘(ii) aggregate information about the 

20 patients served and program activities. 

21 ‘‘(B) Recommendations on whether patient 

22 navigator programs could be used to improve 

23 patient outcomes in other public health areas. 

24 ‘‘(2) INTERIM REPORTS BY SECRETARY.—The 

25 Secretary may provide interim reports to the Con-
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1 gress on the demonstration grant program under 

2 this section at such intervals as the Secretary deter3 mines to be appropriate. 

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

5 Secretary may require grant recipients under this 

6 section to submit interim reports on grant program 

7 outcomes. 

8 ‘‘(i) RULE OF CONSTRUCTION.—This section shall 

9 not be construed to authorize funding for the delivery of 

10 health care services (other than the patient navigator du11 ties listed in subsection (b)). 

12 ‘‘(j) DEFINITIONS.—In this section: 

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

14 or nonprofit private health center (including a Fed15 erally qualified health center (as that term is defined 

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

17 a health facility operated by or pursuant to a con18 tract with the Indian Health Service, a hospital, a 

19 cancer center, a rural health clinic, an academic 

20 health center, or a nonprofit entity that enters into 

21 a partnership or coordinates referrals with such a 

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

23 navigator services. 

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

25 means a population that, as determined by the Sec-
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1 retary, has a significant disparity in the overall rate 

2 of disease incidence, prevalence, morbidity, mor3 tality, or survival rates as compared to the health 

4 status of the general population. 

5 ‘‘(3) The term ‘patient navigator’ means an in6 dividual who has completed a training program ap7 proved by the Secretary to perform the duties listed 

8 in subsection (b). 

9 ‘‘(k) AUTHORIZATION OF APPROPRIATIONS.— 

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

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

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

13 2007, $8,000,000 for fiscal year 2008, $6,500,000 

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

15 2010. 

16 ‘‘(2) AVAILABILITY.—The amounts appro17 priated pursuant to paragraph (1) shall remain 

18 available for obligation through the end of fiscal year 

19 2010.’’. 

Passed the House of Representatives October 5, 

2004. 

Attest: JEFF TRANDAHL, 

Clerk.