IB 

Union Calendar No. 447 

108TH CONGRESS 

2D SESSION H. R. 918 

[Report No. 108–727, Part I] 

To authorize the Health Resources and Services Administration, the National 

Cancer Institute, and the Indian Health Service to make grants for 

model programs to provide to individuals of health disparity populations 

prevention, early detection, treatment, and appropriate follow-up care 

services for cancer and chronic diseases, and to make grants regarding 

patient navigators to assist individuals of health disparity populations 

in receiving such services. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 26, 2003 

Mr. MENENDEZ (for himself, Ms. PRYCE of Ohio, Mr. GREEN of Texas, Ms. 

ROS-LEHTINEN, Mr. THOMPSON of Mississippi, Mr. LINCOLN DIAZBALART of Florida, Mr. RODRIGUEZ, Mrs. WILSON of New Mexico, Mrs. 

CHRISTENSEN, Mr. QUINN, Mr. SERRANO, Mr. MCCOTTER, Mr. 

PALLONE, Mr. PEARCE, Mr. UDALL of New Mexico, and Mr. MARIO

DIAZ-BALART of Florida) introduced the following bill; which was referred to the Committee on Energy and Commerce and in addition to the 

Committee on Resources, for a period to be subsequently determined by 

the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

OCTOBER 5, 2004 

Additional sponsors: Ms. GINNY BROWN-WAITE of Florida, Mr. FROST, Mr. 

FORD, Mr. NORWOOD, Mr. KILDEE, Mr. RENZI, Mr. RANGEL, Mr. 

RAMSTAD, Ms. KILPATRICK, Mr. PICKERING, Mr. CAPUANO, Mrs. 

CAPITO, Mr. MATSUI, Mr. FLETCHER, Mr. ISRAEL, Mr. GRIJALVA, Mr. 

GREEN of Wisconsin, Mr. OBERSTAR, Mr. LAHOOD, Mr. MEEHAN, Mr. 

ROGERS of Michigan, Mr. STUPAK, Mr. PASCRELL, Mr. HOLT, Ms. 

MCCOLLUM, Ms. BALDWIN, Mr. PAYNE, Mr. WHITFIELD, Mr. KIND, Mr. 

GOSS, Mr. PETERSON of Minnesota, Mr. BOOZMAN, Mrs. MCCARTHY of 

New York, Mr. UPTON, Mr. BURNS, Mr. KING of New York, Mr. 

CUNNINGHAM, Mrs. MYRICK, Mr. TIBERI, Mr. SMITH of Washington, Mr. 

COX, Mr. WICKER, Mr. CASTLE, Mr. LATOURETTE, Ms. HOOLEY of Or-
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egon, Mrs. EMERSON, Mr. KIRK, Mr. KLECZKA, Mr. SHIMKUS, Mr. 

WELLER, Mr. SIMMONS, Mr. NETHERCUTT, Mr. RYAN of Wisconsin, Mr. 

ROSS, Mr. COSTELLO, Mr. WALSH, Mr. ROGERS of Kentucky, Mr. SMITH

of New Jersey, Mr. CAMP, Mrs. JONES of Ohio, Mr. BOSWELL, Mr. BARTON of Texas, Mr. GILLMOR, Mr. HALL, Mr. MARSHALL, Mr. SESSIONS, 

Mr. BASS, Mr. JOHNSON of Illinois, Mr. TERRY, Mr. FERGUSON, Mr. 

MCDERMOTT, Mr. HAYWORTH, Mr. LEACH, Mr. EHLERS, Mr. KINGSTON, Mr. BRADLEY of New Hampshire, Mr. KENNEDY of Minnesota, 

Mr. GRAVES, Mr. SCHROCK, Mr. CLAY, Mrs. JO ANN DAVIS of Virginia, 

Ms. JACKSON-LEE of Texas, Mr. BISHOP of Georgia, Mr. HYDE, Mr. 

MOORE, Mr. ISSA, Mr. WAXMAN, Mr. KLINE, Mr. GREENWOOD, Mr. 

DAVIS of Florida, Mr. SCOTT of Virginia, Mr. CRAMER, Mr. FILNER, Mr. 

MCHUGH, Mr. ANDREWS, Mr. REYES, Mr. MICHAUD, Ms. BERKLEY, Ms. 

MCCARTHY of Missouri, Mr. TOWNS, Mr. CUMMINGS, Mrs. KELLY, Mr. 

BELL, Mr. PLATTS, Mr. ALLEN, Mr. KENNEDY of Rhode Island, Mr. 

BISHOP of Utah, Mr. SHAYS, Mr. VITTER, Mr. CARSON of Oklahoma, 

Mr. WYNN, Ms. HERSETH, Mr. WALDEN of Oregon, Mr. ROTHMAN, Mr. 

DEAL of Georgia, Mr. GONZALEZ, and Mr. MCNULTY

OCTOBER 5, 2004 

Reported from the Committee on Energy and Commerce with amendments 

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

OCTOBER 5, 2004 

Referral to the Committee on Resources extended for a period ending not later 

than October 5, 2004 

OCTOBER 5, 2004 

Committee on Resources discharged; committed to the Committee of the 

Whole House on the State of the Union and ordered to be printed 

[For text of introduced bill, see copy of bill as introduced on February 26, 2003] 

A BILL 

To authorize the Health Resources and Services Administration, the National Cancer Institute, and the Indian 

Health Service to make grants for model programs to 

provide to individuals of health disparity populations prevention, early detection, treatment, and appropriate follow-up care services for cancer and chronic diseases, 

and to make grants regarding patient navigators to assist 
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individuals of health disparity populations in receiving 

such services. 

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 ‘‘Patient Navigator Out5 reach and Chronic Disease Prevention Act of 2004’’. 

6 SEC. 2. PATIENT NAVIGATOR GRANTS. 

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

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

9 end the following: 

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

11 ‘‘(a) GRANTS.—The Secretary, acting through the Ad12 ministrator of the Health Resources and Services Adminis13 tration, may make grants to eligible entities for the develop14 ment and operation of demonstration programs to provide 

15 patient navigator services to improve health care outcomes. 

16 The Secretary shall coordinate with, and ensure the partici17 pation of, the Indian Health Service, the National Cancer 

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

19 offices and agencies as deemed appropriate by the Sec20 retary, regarding the design and evaluation of the dem21 onstration programs. 

22 ‘‘(b) USE OF FUNDS.—A condition on the receipt of 

23 a grant under this section is that the grantee agree to use 

24 the grant to recruit, assign, train, and employ patient navi-
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1 gators who have direct knowledge of the communities they 

2 serve to facilitate the care of individuals, including by per3 forming each of the following duties: 

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

5 in the coordination of health care services and pro6 vider referrals, for individuals who are seeking pre7 vention or early detection services for, or who fol8 lowing a screening or early detection service are 

9 found to have a symptom, abnormal finding, or diag10 nosis of, cancer or other chronic disease. 

11 ‘‘(2) Facilitating the involvement of community 

12 organizations providing assistance to individuals who 

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

14 diseases to receive better access to high-quality health 

15 care services (such as by creating partnerships with 

16 patient advocacy groups, charities, health care cen17 ters, community hospice centers, other health care 

18 providers, or other organizations in the targeted com19 munity). 

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

21 facilitating enrollment in these trials if requested and 

22 eligible. 

23 ‘‘(4) Anticipating, identifying, and helping pa24 tients to overcome barriers within the health care sys25 tem to ensure prompt diagnostic and treatment reso-
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1 lution of an abnormal finding of cancer or other 

2 chronic disease. 

3 ‘‘(5) Coordinating with the relevant health insur4 ance ombudsman programs to provide information to 

5 individuals who are at risk for or who have cancer 

6 or other chronic diseases about health coverage, in7 cluding private insurance, health care savings ac8 counts, and other publicly funded programs (such as 

9 Medicare, Medicaid, and the State children’s health 

10 insurance program). 

11 ‘‘(6) Conducting ongoing outreach to health dis12 parity populations, including the uninsured, rural 

13 populations, and other medically underserved popu14 lations, in addition to assisting other individuals who 

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

16 diseases to seek preventative care. 

17 ‘‘(c) GRANT PERIOD.— 

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

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

20 section for periods of not more than 3 years. 

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

22 the Secretary may extend the period of a grant under 

23 this section, except that— 

24 ‘‘(A) each such extension shall be for a pe25 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 grant. 

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

4 this section, the Secretary may not authorize any 

5 grant period ending after September 30, 2010. 

6 ‘‘(d) APPLICATION.— 

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

8 section, an eligible entity shall submit an application 

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

10 containing such information as the Secretary may re11 quire. 

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

13 shall require each such application to outline how the 

14 eligible entity will establish baseline measures and 

15 benchmarks that meet the Secretary’s requirements to 

16 evaluate program outcomes. 

17 ‘‘(e) UNIFORM BASELINE MEASURES.—The Secretary 

18 shall establish uniform baseline measures in order to prop19 erly evaluate the impact of the demonstration projects under 

20 this section. 

21 ‘‘(f) PREFERENCE.—In making grants under this sec22 tion, the Secretary shall give preference to eligible entities 

23 that demonstrate in their applications plans to utilize pa24 tient navigator services to overcome significant barriers in 
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1 order to improve health care outcomes in their respective 

2 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 health 

7 care services. 

8 ‘‘(h) STUDY; REPORTS.— 

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

10 than 6 months after the completion of the demonstra11 tion grant program under this section, the Secretary 

12 shall conduct a study of the results of the program 

13 and submit to the Congress a report on such results 

14 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 pa23 tient 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 this 

2 section at such intervals as the Secretary determines 

3 to be appropriate. 

4 ‘‘(3) INTERIM REPORTS BY GRANTEES.—The Sec5 retary may require grant recipients under this section 

6 to submit interim reports on grant program outcomes. 

7 ‘‘(i) RULE OF CONSTRUCTION.—This section shall not 

8 be construed to authorize funding for the delivery of health 

9 care services (other than the patient navigator duties listed 

10 in subsection (b)). 

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

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

13 nonprofit private health center (including a Federally 

14 qualified health center (as that term is defined in sec15 tion 1861(aa)(4) of the Social Security Act)), a health 

16 facility operated by or pursuant to a contract with 

17 the Indian Health Service, a hospital, a cancer cen18 ter, a rural health clinic, an academic health center, 

19 or a nonprofit entity that enters into a partnership 

20 or coordinates referrals with such a center, clinic, fa21 cility, or hospital to provide patient navigator serv22 ices. 

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

24 means a population that, as determined by the Sec25 retary, has a significant disparity in the overall rate 
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1 of disease incidence, prevalence, morbidity, mortality, 

2 or survival rates as compared to the health status of 

3 the general population. 

4 ‘‘(3) The term ‘patient navigator’ means an in5 dividual who has completed a training program ap6 proved by the Secretary to perform the duties listed 

7 in subsection (b). 

8 ‘‘(k) AUTHORIZATION OF APPROPRIATIONS.— 

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

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

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

12 $8,000,000 for fiscal year 2008, $6,500,000 for fiscal 

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

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

15 pursuant to paragraph (1) shall remain available for 

16 obligation through the end of fiscal year 2010.’’. 

Amend the title so as to read: ‘‘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.’’. 
Union Calendar No. 447 

108TH CONGRESS 

2D SESSION H. R. 918 

[Report No. 108–727, Part I] 

A BILL 

To authorize the Health Resources and Services 

in receiving such services. assist individuals of health disparity populations to make grants regarding patient navigators to care services for cancer and chronic diseases, and tection, treatment, and appropriate follow-up health disparity populations prevention, early defor model programs to provide to individuals of and the Indian Health Service to make grants Administration, the National Cancer Institute, 

OCTOBER 5, 2004 

Reported from the Committee on Energy and Commerce 

O

with amendments 

CTOBER 5, 2004 

Referral to the Committee on Resources extended for a 

period ending not later than October 5, 2004 

OCTOBER 5, 2004 

Committee on Resources discharged; committed to the 

Union and ordered to be printed Committee of the Whole House on the State of the