I 

108TH CONGRESS 

1ST SESSION H. R. 918

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 

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, 

5 Outreach, and Chronic Disease Prevention Act of 2003’’. 

6 SEC. 2. FINDINGS. 

7 The Congress finds as follows: 

8 (1) Despite notable progress in the overall 

9 health of the Nation, there are continuing disparities 

10 in the burden of illness and death experienced by Af11 rican Americans, Latinos and Hispanics, Native 

12 Americans, Alaska Natives, Asian and Pacific Is13 landers and the poor, compared to the United States 

14 population as a whole. 

15 (2) Many racial and ethnic minority groups suf16 fer disproportionately from cancer. Mortality and 

17 morbidity rates remain the most important measures 

18 of the overall progress against cancer. Decreasing 

19 rates of death from cancer reflect improvements in 

20 both prevention and treatment. Among all ethnic 

21 groups in the United States, African American 

22 males have the highest overall rate of mortality from 

23 cancer. Some specific forms of cancer affect other 

24 ethnic minority communities at rates up to several 
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1 times higher than the national averages (such as 

2 stomach and liver cancers among Asian American 

3 populations, colon and rectal cancer among Alaska 

4 natives, and cervical cancer among Hispanic and Vi5 etnamese-American women). 

6 (3) Regions characterized by high rates of pov7 erty also have high mortality for some forms of can8 cer. For example, in Appalachian Kentucky the inci9 dence of lung cancer among white males was 127 

10 per 100,000 in 1992, a rate higher than that for any 

11 ethnic minority group in the United States during 

12 the same period. 

13 (4) Major disparities for other chronic diseases 

14 exist among population groups, with a dispropor15 tionate burden of death and disability from cardio16 vascular disease in racial and ethnic minority and 

17 low-income populations. Compared with rates for the 

18 general population, coronary heart disease mortality 

19 was 40 percent lower for Asian Americans but 40 

20 percent higher for African-Americans. 

21 (5) Minority populations are disproportionately 

22 impacted by diabetes and other chronic diseases. 

23 Hispanics are twice as likely to have diabetes as 

24 non-Hispanic whites; diabetes is the fourth leading 

25 cause of death among Hispanic women and elderly. 
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1 African Americans are 1.7 times as likely to have di2 abetes as the general population. More than 15 per3 cent of the combined populations of Native Ameri4 cans and Alaska Natives have diabetes. 

5 (6) Culturally competent approaches to chronic 

6 disease care are needed to encourage increased par7 ticipation of racial and ethnic minorities and the 

8 medically underserved in chronic disease prevention, 

9 early detection and treatment programs. 

10 SEC. 3. HRSA GRANTS FOR MODEL COMMUNITY CANCER 

11 AND CHRONIC DISEASE CARE AND PREVEN12 TION; HRSA GRANTS FOR PATIENT NAVIGA13 TORS. 

14 Subpart I of part D of title III of the Public Health 

15 Service Act (42 U.S.C. 254b et seq.) is amended by adding 

16 at the end the following: 

17 ‘‘SEC. 330I. MODEL COMMUNITY CANCER AND CHRONIC 

18 DISEASE CARE AND PREVENTION; PATIENT 

19 NAVIGATORS. 

20 ‘‘(a) MODEL COMMUNITY CANCER AND CHRONIC

21 DISEASE CARE AND PREVENTION.—

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

23 through the Administrator of the Health Resources 

24 and Services Administration, may make grants to 

25 public and nonprofit private health centers (includ-
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1 ing health centers under section 330, Indian Health 

2 Service Centers, tribal governments, urban Indian 

3 organizations, tribal organizations, clinics serving 

4 Asian Americans and Pacific Islanders and Alaskan 

5 Natives, and rural health clinics and qualified non6 profit entities that partner with one or more centers 

7 providing health care to provide navigation services,

8 which demonstrate the ability to perform all of the 

9 functions outlined in this subsection and subsections 

10 (b) and (c)) for the development and operation of 

11 model programs that—

12 ‘‘(A) provide to individuals of health dis13 parity populations prevention, early detection, 

14 treatment, and appropriate follow-up care serv15 ices for cancer and chronic diseases; 

16 ‘‘(B) ensure that the health services are 

17 provided to such individuals in a culturally com18 petent manner; 

19 ‘‘(C) assign patient navigators, in accord20 ance with applicable criteria of the Secretary, 

21 for managing the care of individuals of health 

22 disparity populations to—

23 ‘‘(i) accomplish, to the extent possible, 

24 the follow-up and diagnosis of an abnormal 

25 finding and the treatment and appropriate 
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1 follow-up care of cancer or other chronic 

2 disease; and 

3 ‘‘(ii) facilitate access to appropriate 

4 health care services within the health care 

5 system to ensure optimal patient utiliza6 tion of such services, including aid in co7 ordinating and scheduling appointments 

8 and referrals, community outreach, assist9 ance with transportation arrangements, 

10 and assistance with insurance issues and 

11 other barriers to care and providing infor12 mation about clinical trials; 

13 ‘‘(D) require training for patient naviga14 tors employed through such model programs to 

15 ensure the ability of navigators to perform all 

16 of the duties required in this subsection and in 

17 subsection (b), including training to ensure that 

18 navigators are informed about health insurance 

19 systems and are able to aid patients in resolv20 ing access issues; and 

21 ‘‘(E) ensure that consumers have direct ac22 cess to patient navigators during regularly 

23 scheduled hours of business operation. 

24 ‘‘(2) OUTREACH SERVICES.—A condition for 

25 the receipt of a grant under paragraph (1) is that 
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1 the applicant involved agree to provide ongoing out2 reach activities while receiving the grant, in a man3 ner that is culturally competent for the health dis4 parity population served by the program, to inform 

5 the public and the specific community that the pro6 gram is serving of the services of the model program 

7 under the grant. Such activities shall include facili8 tating access to appropriate health care services and 

9 patient navigators within the health care system to 

10 ensure optimal patient utilization of these services. 

11 ‘‘(3) DATA COLLECTION AND REPORT.—In 

12 order to allow for effective program evaluation, the 

13 grantee shall collect specific patient data recording 

14 services provided to each patient served by the pro15 gram and shall establish and implement procedures 

16 and protocols, consistent with applicable Federal and 

17 State laws (including 45 C.F.R. 160 and 164) to en18 sure the confidentiality of all information shared by 

19 a participant in the program, or their personal rep20 resentative and their health care providers, group 

21 health plans, or health insurance insurers with the 

22 program. The program may, consistent with applica23 ble Federal and State confidentiality laws, collect, 

24 use or disclose aggregate information that is not in25 dividually identifiable (as defined in 45 C.F.R. 160 
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1 and 164). With this data, the grantee shall submit 

2 an annual report to the Secretary that summarizes 

3 and analyzes these data, provides information on 

4 needs for navigation services, types of access difficul5 ties resolved, sources of repeated resolution and 

6 flaws in the system of access, including insurance 

7 barriers. 

8 ‘‘(4) APPLICATION FOR GRANT.—A grant may 

9 be made under paragraph (1) only if an application 

10 for the grant is submitted to the Secretary and the 

11 application is in such form, is made in such manner, 

12 and contains such agreements, assurances, and in13 formation as the Secretary determines to be nec14 essary to carry out this section. 

15 ‘‘(5) EVALUATIONS.—

16 ‘‘(A) IN GENERAL.—The Secretary, acting 

17 through the Administrator of the Health Re18 sources and Services Administration, shall, di19 rectly or through grants or contracts, provide 

20 for evaluations to determine which outreach ac21 tivities under paragraph (2) were most effective 

22 in informing the public and the specific commu23 nity that the program is serving of the model 

24 program services and to determine the extent to 

25 which such programs were effective in providing 
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1 culturally competent services to the health dis2 parity population served by the programs. 

3 ‘‘(B) DISSEMINATION OF FINDINGS.—The 

4 Secretary shall as appropriate disseminate to 

5 public and private entities the findings made in 

6 evaluations under subparagraph (A). 

7 ‘‘(6) COORDINATION WITH OTHER PRO8 GRAMS.—The Secretary shall coordinate the pro9 gram under this subsection with the program under 

10 subsection (b), with the program under section 

11 417D, and to the extent practicable, with programs 

12 for prevention centers that are carried out by the 

13 Director of the Centers for Disease Control and Pre14 vention. 

15 ‘‘(b) PROGRAM FOR PATIENT NAVIGATORS.—

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

17 through the Administrator of the Health Resources 

18 and Services Administration, may make grants to 

19 public and nonprofit private health centers (includ20 ing health centers under section 330, Indian Health 

21 Service Centers, tribal governments, urban Indian 

22 organizations, tribal organizations, clinics serving 

23 Asian Americans and Pacific Islanders and Alaskan 

24 Natives, and rural health clinics and qualified non25 profit entities that partner with one or more centers 
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1 providing health care to provide navigation services, 

2 which demonstrate the ability to perform all of the 

3 functions outlined in this subsection and subsections 

4 (a) and (c)) for the development and operation of 

5 programs to pay the costs of such health centers 

6 in—

7 ‘‘(A) assigning patient navigators, in ac8 cordance with applicable criteria of the Sec9 retary, for managing the care of individuals of 

10 health disparity populations for the duration of 

11 receiving health services from the health cen12 ters, including aid in coordinating and sched13 uling appointments and referrals, community 

14 outreach, assistance with transportation ar15 rangements, and assistance with insurance 

16 issues and other barriers to care and providing 

17 information about clinical trials; 

18 ‘‘(B) ensuring that the services provided by 

19 the patient navigators to such individuals in20 clude case management and psychosocial as21 sessment and care or information and referral 

22 to such services; 

23 ‘‘(C) ensuring that patient navigators with 

24 direct knowledge of the communities they serve 
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1 provide services to such individuals in a cul2 turally competent manner; 

3 ‘‘(D) developing model practices for patient 

4 navigators, including with respect to—

5 ‘‘(i) coordination of health services, 

6 including psychosocial assessment and 

7 care; 

8 ‘‘(ii) appropriate follow-up care, in9 cluding psychosocial assessment and care; 

10 ‘‘(iii) determining coverage under 

11 health insurance and health plans for all 

12 services; 

13 ‘‘(iv) ensuring the initiation, continu14 ation and/or sustained access to care pre15 scribed by the patients’ health care pro16 viders; and 

17 ‘‘(v) aiding patients with health insur18 ance coverage issues; 

19 ‘‘(E) requiring training for patient naviga20 tors to ensure the ability of navigators to per21 form all of the duties required in this sub22 section and in subsection (a), including training 

23 to ensure that navigators are informed about 

24 health insurance systems and are able to aid 

25 patients in resolving access issues; and 
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1 ‘‘(F) ensuring that consumers have direct 

2 access to patient navigators during regularly 

3 scheduled hours of business operation. 

4 ‘‘(2) OUTREACH SERVICES.—A condition for 

5 the receipt of a grant under paragraph (1) is that 

6 the applicant involved agree to provide ongoing out7 reach activities while receiving the grant, in a man8 ner that is culturally competent for the health dis9 parity population served by the program, to inform 

10 the public and the specific community that the pa11 tient navigator is serving of the services of the model 

12 program under the grant. 

13 ‘‘(3) DATA COLLECTION AND REPORT.—In 

14 order to allow for effective patient navigator pro15 gram evaluation, the grantee shall collect specific pa16 tient data recording navigation services provided to 

17 each patient served by the program and shall estab18 lish and implement procedures and protocols, con19 sistent with applicable Federal and State laws (in20 cluding 45 C.F.R. 160 and 164) to ensure the con21 fidentiality of all information shared by a participant 

22 in the program, or their personal representative and 

23 their health care providers, group health plans, or 

24 health insurance insurers with the program. The pa25 tient navigator program may, consistent with appli-
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1 cable Federal and State confidentiality laws, collect, 

2 use or disclose aggregate information that is not in3 dividually identifiable (as defined in 45 C.F.R. 160 

4 and 164). With this data, the grantee shall submit 

5 an annual report to the Secretary that summarizes 

6 and analyzes these data, provides information on 

7 needs for navigation services, types of access difficul8 ties resolved, sources of repeated resolution and 

9 flaws in the system of access, including insurance 

10 barriers. 

11 ‘‘(4) APPLICATION FOR GRANT.—A grant may 

12 be made under paragraph (1) only if an application 

13 for the grant is submitted to the Secretary and the 

14 application is in such form, is made in such manner, 

15 and contains such agreements, assurances, and in16 formation as the Secretary determines to be nec17 essary to carry out this section. 

18 ‘‘(5) EVALUATIONS.—

19 ‘‘(A) IN GENERAL.—The Secretary, acting 

20 through the Administrator of the Health Re21 sources and Services Administration, shall, di22 rectly or through grants or contracts, provide 

23 for evaluations to determine the effects of the 

24 services of patient navigators on the individuals 

25 of health disparity populations for whom the 
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1 services were provided, taking into account the 

2 matters referred to in paragraph (1)(C). 

3 ‘‘(B) DISSEMINATION OF FINDINGS.—The 

4 Secretary shall as appropriate disseminate to 

5 public and private entities the findings made in 

6 evaluations under subparagraph (A).

7 ‘‘(6) COORDINATION WITH OTHER PRO8 GRAMS.—The Secretary shall coordinate the pro9 gram under this subsection with the program under 

10 subsection (a) and with the program under section 

11 417D. 

12 ‘‘(c) REQUIREMENTS REGARDING FEES.—

13 ‘‘(1) IN GENERAL.—A condition for the receipt 

14 of a grant under subsection (a)(1) or (b)(1) is that 

15 the program for which the grant is made have in ef16 fect—

17 ‘‘(A) a schedule of fees or payments for 

18 the provision of its health care services related 

19 to the prevention and treatment of disease that 

20 is consistent with locally prevailing rates or 

21 charges and is designed to cover its reasonable 

22 costs of operation; and 

23 ‘‘(B) a corresponding schedule of discounts 

24 to be applied to the payment of such fees or 
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1 payments, which discounts are adjusted on the 

2 basis of the ability of the patient to pay. 

3 ‘‘(2) RULE OF CONSTRUCTION.—Nothing in 

4 this section shall be construed to require payment 

5 for navigation services or to require payment for 

6 health care services in cases where care is provided 

7 free of charge, including the case of services pro8 vided through programs of the Indian Health Serv9 ice. 

10 ‘‘(d) MODEL.—Not later than five years after the 

11 date of the enactment of this section, the Secretary shall 

12 develop a peer-reviewed model of systems for the services 

13 provided by this section. The Secretary shall update such 

14 model as may be necessary to ensure that the best prac15 tices are being utilized. 

16 ‘‘(e) DURATION OF GRANT.—The period during 

17 which payments are made to an entity from a grant under 

18 subsection (a)(1) or (b)(1) may not exceed five years. The 

19 provision of such payments are subject to annual approval 

20 by the Secretary of the payments and subject to the avail21 ability of appropriations for the fiscal year involved to 

22 make the payments. This subsection may not be construed 

23 as establishing a limitation on the number of grants under 

24 such subsection that may be made to an entity. 

25 ‘‘(f) DEFINITIONS.—For purposes of this section: 
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1 ‘‘(1) The term ‘culturally competent’, with re2 spect to providing health-related services, means 

3 services that, in accordance with standards and 

4 measures of the Secretary, are designed to effec5 tively and efficiently respond to the cultural and lin6 guistic needs of patients. 

7 ‘‘(2) The term ‘appropriate follow-up care’ in8 cludes palliative and end-of-life care. 

9 ‘‘(3) The term ‘health disparity population’ 

10 means a population where there exists a significant 

11 disparity in the overall rate of disease incidence, 

12 morbidity, mortality, or survival rates in the popu13 lation as compared to the health status of the gen14 eral population. Such term includes—

15 ‘‘(A) racial and ethnic minority groups as 

16 defined in section 1707; and 

17 ‘‘(B) medically underserved groups, such 

18 as rural and low-income individuals and individ19 uals with low levels of literacy. 

20 ‘‘(4)(A) The term ‘patient navigator’ means an 

21 individual whose functions include—

22 ‘‘(i) assisting and guiding patients with a 

23 symptom or an abnormal finding or diagnosis of 

24 cancer or other chronic disease within the 

25 health care system to accomplish the follow-up 
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1 and diagnosis of an abnormal finding as well as 

2 the treatment and appropriate follow-up care of 

3 cancer or other chronic disease including pro4 viding information about clinical trials; and 

5 ‘‘(ii) identifying, anticipating, and helping 

6 patients overcome barriers within the health 

7 care system to ensure prompt diagnostic and 

8 treatment resolution of an abnormal finding of 

9 cancer or other chronic disease. 

10 ‘‘(B) Such term includes representatives of the 

11 target health disparity population, such as nurses, 

12 social workers, cancer survivors, and patient advo13 cates. 

14 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—

15 ‘‘(1) IN GENERAL.—

16 ‘‘(A) MODEL PROGRAMS.—For the purpose 

17 of carrying out subsection (a) (other than the 

18 purpose described in paragraph (2)(A)), there 

19 are authorized to be appropriated such sums as 

20 may be necessary for each of the fiscal years 

21 2004 through 2008. 

22 ‘‘(B) PATIENT NAVIGATORS.—For the pur23 pose of carrying out subsection (b) (other than 

24 the purpose described in paragraph (2)(B)), 

25 there are authorized to be appropriated such 
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1 sums as may be necessary for each of the fiscal 

2 years 2004 through 2008. 

3 ‘‘(C) BUREAU OF PRIMARY HEALTH

4 CARE.—Amounts appropriated under subpara5 graph (A) or (B) shall be administered through 

6 the Bureau of Primary Health Care. 

7 ‘‘(2) PROGRAMS IN RURAL AREAS.—

8 ‘‘(A) MODEL PROGRAMS.—For the purpose 

9 of carrying out subsection (a) by making grants 

10 under such subsection for model programs in 

11 rural areas, there are authorized to be appro12 priated such sums as may be necessary for each 

13 of the fiscal years 2004 through 2008. 

14 ‘‘(B) PATIENT NAVIGATORS.—For the pur15 pose of carrying out subsection (b) by making 

16 grants under such subsection for programs in 

17 rural areas, there are authorized to be appro18 priated such sums as may be necessary for each 

19 of the fiscal years 2004 through 2008. 

20 ‘‘(C) OFFICE OF RURAL HEALTH POL21 ICY.—Amounts appropriated under subpara22 graph (A) or (B) shall be administered through 

23 the Office of Rural Health Policy. 

24 ‘‘(3) RELATION TO OTHER AUTHORIZATIONS.—

25 Authorizations of appropriations under paragraphs 
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1 (1) and (2) are in addition to other authorizations 

2 of appropriations that are available for the purposes 

3 described in such paragraphs.’’.

4 SEC. 4. NCI GRANTS FOR MODEL COMMUNITY CANCER AND 

5 CHRONIC DISEASE CARE AND PREVENTION; 

6 NCI GRANTS FOR PATIENT NAVIGATORS. 

7 Subpart 1 of part C of title IV of the Public Health 

8 Service Act (42 U.S.C. 285 et seq.) is amended by adding 

9 at the end following section: 

10 ‘‘SEC. 417D. MODEL COMMUNITY CANCER AND CHRONIC 

11 DISEASE CARE AND PREVENTION; PATIENT 

12 NAVIGATORS. 

13 ‘‘(a) MODEL COMMUNITY CANCER AND CHRONIC

14 DISEASE CARE AND PREVENTION.—

15 ‘‘(1) IN GENERAL.—The Director of the Insti16 tute may make grants to eligible entities for the de17 velopment and operation of model programs that—

18 ‘‘(A) provide to individuals of health dis19 parity populations prevention, early detection, 

20 treatment, and appropriate follow-up care serv21 ices for cancer and chronic diseases; 

22 ‘‘(B) ensure that the health services are 

23 provided to such individuals in a culturally com24 petent manner; 
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1 ‘‘(C) assign patient navigators, in accord2 ance with applicable criteria of the Secretary, 

3 for managing the care of individuals of health 

4 disparity populations to—

5 ‘‘(i) accomplish, to the extent possible, 

6 the follow-up and diagnosis of an abnormal 

7 finding and the treatment and appropriate 

8 follow-up care of cancer or other chronic 

9 disease; and 

10 ‘‘(ii) facilitate access to appropriate 

11 health care services within the health care 

12 system to ensure optimal patient utiliza13 tion of such services, including aid in co14 ordinating and scheduling appointments 

15 and referrals, community outreach, assist16 ance with transportation arrangements, 

17 and assistance with insurance issues and 

18 other barriers to care and providing infor19 mation about clinical trials; 

20 ‘‘(D) require training for patient naviga21 tors employed through such model programs to 

22 ensure the ability of navigators to perform all 

23 of the duties required in this subsection and in 

24 subsection (b), including training to ensure that 

25 navigators are informed about health insurance 
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1 systems and are able to aid patients in resolv2 ing access issues; and 

3 ‘‘(E) ensure that consumers have direct ac4 cess to patient navigators during regularly 

5 scheduled hours of business operation. 

6 ‘‘(2) ELIGIBLE ENTITIES.—For purposes of this 

7 section, an eligible entity is a designated cancer cen8 ter of the Institute, an academic institution, Indian 

9 Health Service Clinics, tribal governments, urban In10 dian organizations, tribal organizations, a hospital, a 

11 qualified nonprofit entity that partners with one or 

12 more centers providing health care to provide navi13 gation services, which demonstrates the ability to 

14 perform all of the functions outlined in this sub15 section and subsections (b) and (c), or any other 

16 public or private entity determined to be appropriate 

17 by the Director of the Institute, that provides serv18 ices described in paragraph (1)(A) for cancer and 

19 chronic diseases. 

20 ‘‘(3) DATA COLLECTION AND REPORT.—In 

21 order to allow for effective program evaluation, the 

22 grantee shall collect specific patient data recording 

23 services provided to each patient served by the pro24 gram and shall establish and implement procedures 

25 and protocols, consistent with applicable Federal and 
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1 State laws (including 45 C.F.R. 160 and 164) to en2 sure the confidentiality of all information shared by 

3 a participant in the program, or their personal rep4 resentative and their health care providers, group 

5 health plans, or health insurance insurers with the 

6 program. The program may, consistent with applica7 ble Federal and State confidentiality laws, collect, 

8 use or disclose aggregate information that is not in9 dividually identifiable (as defined in 45 CFR 160 

10 and 164). With this data, the grantee shall submit 

11 an annual report to the Secretary that summarizes 

12 and analyzes these data, provides information on 

13 needs for navigation services, types of access difficul14 ties resolved, sources of repeated resolution and 

15 flaws in the system of access, including insurance 

16 barriers. 

17 ‘‘(4) OUTREACH SERVICES.—A condition for 

18 the receipt of a grant under paragraph (1) is that 

19 the applicant involved agree to provide ongoing out20 reach activities while receiving the grant, in a man21 ner that is culturally competent for the health dis22 parity population served by the program, to inform 

23 the public and the specific community that the pro24 gram is serving of the services of the model program 

25 under the grant. Such activities shall include facili-
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1 tating access to appropriate health care services and 

2 patient navigators within the health care system to 

3 ensure optimal patient utilization of these services. 

4 ‘‘(5) APPLICATION FOR GRANT.—A grant may 

5 be made under paragraph (1) only if an application 

6 for the grant is submitted to the Director of the In7 stitute and the application is in such form, is made 

8 in such manner, and contains such agreements, as9 surances, and information as the Director deter10 mines to be necessary to carry out this section. 

11 ‘‘(6) EVALUATIONS.—

12 ‘‘(A) IN GENERAL.—The Director of the 

13 Institute, directly or through grants or con14 tracts, shall provide for evaluations to deter15 mine which outreach activities under paragraph 

16 (3) were most effective in informing the public 

17 and the specific community that the program is 

18 serving of the model program services and to 

19 determine the extent to which such programs 

20 were effective in providing culturally competent 

21 services to the health disparity population 

22 served by the programs. 

23 ‘‘(B) DISSEMINATION OF FINDINGS.—The 

24 Director of the Institute shall as appropriate 

25 disseminate to public and private entities the 
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1 findings made in evaluations under subpara2 graph (A). 

3 ‘‘(7) COORDINATION WITH OTHER PRO4 GRAMS.—The Secretary shall coordinate the pro5 gram under this subsection with the program under

6 subsection (b), with the program under section 330I, 

7 and to the extent practicable, with programs for pre8 vention centers that are carried out by the Director 

9 of the Centers for Disease Control and Prevention. 

10 ‘‘(b) PROGRAM FOR PATIENT NAVIGATORS.—

11 ‘‘(1) IN GENERAL.—The Director of the Insti12 tute may make grants to eligible entities for the de13 velopment and operation of programs to pay the 

14 costs of such entities in—

15 ‘‘(A) assigning patient navigators, in ac16 cordance with applicable criteria of the Sec17 retary, for managing the care of individuals of 

18 health disparity populations for the duration of 

19 receiving health services from the health cen20 ters, including aid in coordinating and sched21 uling appointments and referrals, community 

22 outreach, assistance with transportation ar23 rangements, and assistance with insurance 

24 issues and other barriers to care and providing 

25 information about clinical trials; 
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1 ‘‘(B) ensuring that the services provided by 

2 the patient navigators to such individuals in3 clude case management and psychosocial as4 sessment and care or information and referral 

5 to such services; 

6 ‘‘(C) ensuring that the patient navigators 

7 with direct knowledge of the communities they 

8 serve provide services to such individuals in a 

9 culturally competent manner; 

10 ‘‘(D) developing model practices for patient 

11 navigators, including with respect to—

12 ‘‘(i) coordination of health services, 

13 including psychosocial assessment and 

14 care; 

15 ‘‘(ii) follow-up services, including psy16 chosocial assessment and care; 

17 ‘‘(iii) determining coverage under 

18 health insurance and health plans for all 

19 services; 

20 ‘‘(iv) ensuring the initiation, continu21 ation and/or sustained access to care pre22 scribed by the patients’ health care pro23 viders; and 

24 ‘‘(v) aiding patients with health insur25 ance coverage issues; 
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1 ‘‘(E) requiring training for patient naviga2 tors to ensure the ability of navigators to per3 form all of the duties required in this sub4 section and in subsection (a), including training 

5 to ensure that navigators are informed about 

6 health insurance systems and are able to aid 

7 patients in resolving access issues; and 

8 ‘‘(F) ensuring that consumers have direct 

9 access to patient navigators during regularly 

10 scheduled hours of business operation. 

11 ‘‘(2) OUTREACH SERVICES.—A condition for 

12 the receipt of a grant under paragraph (1) is that 

13 the applicant involved agree to provide ongoing out14 reach activities while receiving the grant, in a man15 ner that is culturally competent for the health dis16 parity population served by the program, to inform 

17 the public and the specific community that the pa18 tient navigator is serving of the services of the model 

19 program under the grant. 

20 ‘‘(3) DATA COLLECTION AND REPORT.—In 

21 order to allow for effective patient navigator pro22 gram evaluation, the grantee shall collect specific pa23 tient data recording navigation services provided to 

24 each patient served by the program and shall estab25 lish and implement procedures and protocols, con-
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1 sistent with applicable Federal and State laws (in2 cluding 45 C.F.R. 160 and 164) to ensure the con3 fidentiality of all information shared by a participant 

4 in the program, or their personal representative and 

5 their health care providers, group health plans, or 

6 health insurance insurers with the program. The pa7 tient navigator program may, consistent with appli8 cable Federal and State confidentiality laws, collect, 

9 use or disclose aggregate information that is not in10 dividually identifiable (as defined in 45 C.F.R. 160 

11 and 164). With this data, the grantee shall submit 

12 an annual report to the Secretary that summarizes 

13 and analyzes these data, provides information on 

14 needs for navigation services, types of access difficul15 ties resolved, sources of repeated resolution and 

16 flaws in the system of access, including insurance 

17 barriers. 

18 ‘‘(4) APPLICATION FOR GRANT.—A grant may 

19 be made under paragraph (1) only if an application 

20 for the grant is submitted to the Director of the In21 stitute and the application is in such form, is made 

22 in such manner, and contains such agreements, as23 surances, and information as the Director deter24 mines to be necessary to carry out this section. 

25 ‘‘(5) EVALUATIONS.—
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1 ‘‘(A) IN GENERAL.—The Director of the 

2 Institute, directly or through grants or con3 tracts, shall provide for evaluations to deter4 mine the effects of the services of patient navi5 gators on the health disparity population for 

6 whom the services were provided, taking into 

7 account the matters referred to in paragraph 

8 (1)(C).

9 ‘‘(B) DISSEMINATION OF FINDINGS.—The 

10 Director of the Institute shall as appropriate 

11 disseminate to public and private entities the 

12 findings made in evaluations under subpara13 graph (A). 

14 ‘‘(6) COORDINATION WITH OTHER PRO15 GRAMS.—The Secretary shall coordinate the pro16 gram under this subsection with the program under 

17 subsection (a) and with the program under section 

18 330I. 

19 ‘‘(c) REQUIREMENTS REGARDING FEES.—

20 ‘‘(1) IN GENERAL.—A condition for the receipt 

21 of a grant under subsection (a)(1) or (b)(1) is that 

22 the program for which the grant is made have in ef23 fect—

24 ‘‘(A) a schedule of fees or payments for 

25 the provision of its health care services related 
29

•HR 918 IH 

1 to the prevention and treatment of disease that 

2 is consistent with locally prevailing rates or 

3 charges and is designed to cover its reasonable 

4 costs of operation; and

5 ‘‘(B) a corresponding schedule of discounts 

6 to be applied to the payment of such fees or 

7 payments, which discounts are adjusted on the 

8 basis of the ability of the patient to pay. 

9 ‘‘(2) RULE OF CONSTRUCTION.—Nothing in 

10 this section shall be construed to require payment 

11 for navigation services or to require payment for 

12 health care services in cases where care is provided 

13 free of charge, including the case of services pro14 vided through programs of the Indian Health Serv15 ice. 

16 ‘‘(d) MODEL.—Not later than five years after the 

17 date of the enactment of this section, the Director of the 

18 Institute shall develop a peer-reviewed model of systems 

19 for the services provided by this section. The Director shall 

20 update such model as may be necessary to ensure that 

21 the best practices are being utilized. 

22 ‘‘(e) DURATION OF GRANT.—The period during 

23 which payments are made to an entity from a grant under 

24 subsection (a)(1) or (b)(1) may not exceed five years. The 

25 provision of such payments are subject to annual approval 
30

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1 by the Director of the Institute of the payments and sub2 ject to the availability of appropriations for the fiscal year 

3 involved to make the payments. This subsection may not 

4 be construed as establishing a limitation on the number 

5 of grants under such subsection that may be made to an 

6 entity. 

7 ‘‘(f) DEFINITIONS.—For purposes of this section: 

8 ‘‘(1) The term ‘culturally competent’, with re9 spect to providing health-related services, means 

10 services that, in accordance with standards and 

11 measures of the Secretary, are designed to effec12 tively and efficiently respond to the cultural and lin13 guistic needs of patients. 

14 ‘‘(2) the term ‘appropriate follow-up care’ in15 cludes palliative and end-of-life care. 

16 ‘‘(3) the term ‘health disparity population’ 

17 means a population where there exists a significant 

18 disparity in the overall rate of disease incidence, 

19 morbidity, mortality, or survival rates in the popu20 lation as compared to the health status of the gen21 eral population. Such term includes—

22 ‘‘(A) racial and ethnic minority groups as 

23 defined in section 1707; and 
31

•HR 918 IH 

1 ‘‘(B) medically underserved groups, such 

2 as rural and low-income individuals and individ3 uals with low levels of literacy. 

4 ‘‘(4)(A) the term ‘patient navigator’ means an 

5 individual whose functions include—

6 ‘‘(i) assisting and guiding patients with a 

7 symptom or an abnormal finding or diagnosis of 

8 cancer or other chronic disease within the 

9 health care system to accomplish the follow-up 

10 and diagnosis of an abnormal finding as well as 

11 the treatment and appropriate follow-up care of 

12 cancer or other chronic disease, including pro13 viding information about clinical trials; and 

14 ‘‘(ii) identifying, anticipating, and helping 

15 patients overcome barriers within the health 

16 care system to ensure prompt diagnostic and 

17 treatment resolution of an abnormal finding of 

18 cancer or other chronic disease. 

19 ‘‘(B) Such term includes representatives of the 

20 target health disparity population, such as nurses, 

21 social workers, cancer survivors, and patient advo22 cates. 

23 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—

24 ‘‘(1) MODEL PROGRAMS.—For the purpose of 

25 carrying out subsection (a), there are authorized to 
32

•HR 918 IH 

1 be appropriated such sums as may be necessary for 

2 each of the fiscal years 2004 through 2008. 

3 ‘‘(2) PATIENT NAVIGATORS.—For the purpose 

4 of carrying out subsection (b), there are authorized 

5 to be appropriated such sums as may be necessary 

6 for each of the fiscal years 2004 through 2008. 

7 ‘‘(3) RELATION TO OTHER AUTHORIZATIONS.—

8 Authorizations of appropriations under paragraphs 

9 (1) and (2) are in addition to other authorizations 

10 of appropriations that are available for the purposes 

11 described in such paragraphs.’’. 

12 SEC. 5. IHS GRANTS FOR MODEL COMMUNITY CANCER AND 

13 CHRONIC DISEASE CARE AND PREVENTION; 

14 IHS GRANTS FOR PATIENT NAVIGATORS. 

15 (a) MODEL COMMUNITY CANCER AND CHRONIC DIS16 EASE CARE AND PREVENTION.—

17 (1) IN GENERAL.—The Director of the Indian 

18 Health Service may make grants to Indian Health 

19 Service Centers, tribal governments, urban Indian 

20 organizations, tribal organizations, and qualified 

21 nonprofit entities demonstrating the ability to per22 form all of the functions outlined in this subsection 

23 and subsections (b) and (c) that partner with pro24 viders or centers providing health care serving Na25 tive American populations to provide navigation 
33

•HR 918 IH 

1 services, for the development and operation of model 

2 programs that—

3 (A) provide to individuals of health dis4 parity populations prevention, early detection,

5 treatment, and appropriate follow-up care serv6 ices for cancer and chronic diseases; 

7 (B) ensure that the health services are pro8 vided to such individuals in a culturally com9 petent manner; 

10 (C) assign patient navigators, in accord11 ance with applicable criteria of the Secretary, 

12 for managing the care of individuals of health 

13 disparity populations to—

14 (i) accomplish, to the extent possible, 

15 the follow-up and diagnosis of an abnormal 

16 finding and the treatment and appropriate 

17 follow-up care of cancer or other chronic 

18 disease; and 

19 (ii) facilitate access to appropriate 

20 health care services within the health care 

21 system to ensure optimal patient utiliza22 tion of such services, including aid in co23 ordinating and scheduling appointments 

24 and referrals, community outreach, assist25 ance with transportation arrangements, 
34

•HR 918 IH 

1 and assistance with insurance issues and 

2 other barriers to care and providing infor3 mation about clinical trials; 

4 (D) require training for patient navigators 

5 employed through such model programs to en6 sure the ability of navigators to perform all of 

7 the duties required in this subsection and in 

8 subsection (b), including training to ensure that 

9 navigators are informed about health insurance 

10 systems and are able to aid patients in resolv11 ing access issues; and 

12 (E) ensure that consumers have direct ac13 cess to patient navigators during regularly 

14 scheduled hours of business operation. 

15 (2) OUTREACH SERVICES.—A condition for the 

16 receipt of a grant under paragraph (1) is that the 

17 applicant involved agree to provide ongoing outreach 

18 activities while receiving the grant, in a manner that 

19 is culturally competent for the health disparity popu20 lation served by the program, to inform the public 

21 and the specific community that the program is 

22 serving of the services of the model program under 

23 the grant. Such activities shall include facilitating 

24 access to appropriate health care services and pa-
35

•HR 918 IH 

1 tient navigators within the health care system to en2 sure optimal patient utilization of these services. 

3 (3) DATA COLLECTION AND REPORT.—In order 

4 to allow for effective program evaluation, the grantee 

5 shall collect specific patient data recording services 

6 provided to each patient served by the program and 

7 shall establish and implement procedures and proto8 cols, consistent with applicable Federal and State 

9 laws (including 45 C.F.R. 160 and 164) to ensure 

10 the confidentiality of all information shared by a 

11 participant in the program, or their personal rep12 resentative and their health care providers, group 

13 health plans, or health insurance insurers with the 

14 program. The program may, consistent with applica15 ble Federal and State confidentiality laws, collect, 

16 use or disclose aggregate information that is not in17 dividually identifiable (as defined in 45 C.F.R. 160 

18 and 164). With this data, the grantee shall submit 

19 an annual report to the Secretary that summarizes 

20 and analyzes these data, provides information on 

21 needs for navigation services, types of access difficul22 ties resolved, sources of repeated resolution and 

23 flaws in the system of access, including insurance 

24 barriers. 
36

•HR 918 IH 

1 (4) APPLICATION FOR GRANT.—A grant may be 

2 made under paragraph (1) only if an application for 

3 the grant is submitted to the Secretary and the ap4 plication is in such form, is made in such manner, 

5 and contains such agreements, assurances, and in6 formation as the Secretary determines to be nec7 essary to carry out this section. 

8 (5) EVALUATIONS.—

9 (A) IN GENERAL.—The Secretary, acting 

10 through the Director of the Indian Health Serv11 ice, shall, directly or through grants or con12 tracts, provide for evaluations to determine 

13 which outreach activities under paragraph (2) 

14 were most effective in informing the public and 

15 the specific community that the program is 

16 serving of the model program services and to 

17 determine the extent to which such programs 

18 were effective in providing culturally competent 

19 services to the health disparity population 

20 served by the programs. 

21 (B) DISSEMINATION OF FINDINGS.—The 

22 Secretary shall as appropriate disseminate to 

23 public and private entities the findings made in 

24 evaluations under subparagraph (A). 
37

•HR 918 IH 

1 (6) COORDINATION WITH OTHER PROGRAMS.—

2 The Secretary shall coordinate the program under 

3 this subsection with the program under subsection 

4 (b), with the program under section 417D, and to 

5 the extent practicable, with programs for prevention 

6 centers that are carried out by the Director of the 

7 Centers for Disease Control and Prevention. 

8 (b) PROGRAM FOR PATIENT NAVIGATORS.—

9 (1) IN GENERAL.—The Secretary, acting 

10 through the Director of the Indian Health Service, 

11 may make grants to Indian Health Service Centers, 

12 tribal governments, urban Indian organizations, trib13 al organizations, and qualified nonprofit entities 

14 demonstrating the ability to perform all of the func15 tions outlined in this subsection and subsections (a) 

16 and (c) that partner with providers or centers pro17 viding health care serving Native American popu18 lations to provide navigation services, for the devel19 opment and operation of model programs to pay the 

20 costs of such organizations in—

21 (A) assigning patient navigators, in accord22 ance with applicable criteria of the Secretary, 

23 for individuals of health disparity populations 

24 for the duration of receiving health services 

25 from the health centers, including aid in coordi-
38

•HR 918 IH 

1 nating and scheduling appointments and refer2 rals, community outreach, assistance with 

3 transportation arrangements, and assistance 

4 with insurance issues and other barriers to care 

5 and providing information about clinical trials; 

6 (B) ensuring that the services provided by 

7 the patient navigators to such individuals in8 clude case management and psychosocial as9 sessment and care or information and referral 

10 to such services; 

11 (C) ensuring that patient navigators with 

12 direct knowledge of the communities they serve 

13 provide services to such individuals in a cul14 turally competent manner; 

15 (D) developing model practices for patient 

16 navigators, including with respect to—

17 (i) coordination of health services, in18 cluding psychosocial assessment and care; 

19 (ii) appropriate follow-up care, includ20 ing psychosocial assessment and care; 

21 (iii) determining coverage under 

22 health insurance and health plans for all 

23 services; 

24 (iv) ensuring the initiation, continu25 ation and/or sustained access to care pre-
39

•HR 918 IH 

1 scribed by the patients’ health care pro2 viders; and 

3 (v) aiding patients with health insur4 ance coverage issues; 

5 (E) requiring training for patient naviga6 tors to ensure the ability of navigators to per7 form all of the duties required in this sub8 section and in subsection (a), including training 

9 to ensure that navigators are informed about 

10 health insurance systems and are able to aid 

11 patients in resolving access issues; and 

12 (F) ensuring that consumers have direct 

13 access to patient navigators during regularly 

14 scheduled hours of business operation. 

15 (2) OUTREACH SERVICES.—A condition for the 

16 receipt of a grant under paragraph (1) is that the 

17 applicant involved agree to provide ongoing outreach 

18 activities while receiving the grant, in a manner that 

19 is culturally competent for the health disparity popu20 lation served by the program, to inform the public 

21 and the specific community that the patient navi22 gator is serving of the services of the model program 

23 under the grant. 

24 (3) DATA COLLECTION AND REPORT.—In order 

25 to allow for effective patient navigator program eval-
40

•HR 918 IH 

1 uation, the grantee shall collect specific patient data 

2 recording navigation services provided to each pa3 tient served by the program and shall establish and 

4 implement procedures and protocols, consistent with 

5 applicable Federal and State laws (including 45 

6 C.F.R. 160 and 164) to ensure the confidentiality of 

7 all information shared by a participant in the pro8 gram, or their personal representative and their 

9 health care providers, group health plans, or health 

10 insurance insurers with the program. The patient 

11 navigator program may, consistent with applicable 

12 Federal and State confidentiality laws, collect, use or 

13 disclose aggregate information that is not individ14 ually identifiable (as defined in 45 C.F.R. 160 and 

15 164). With this data, the grantee shall submit an 

16 annual report to the Secretary that summarizes and 

17 analyzes these data, provides information on needs 

18 for navigation services, types of access difficulties re19 solved, sources of repeated resolution and flaws in 

20 the system of access, including insurance barriers. 

21 (4) APPLICATION FOR GRANT.—A grant may be 

22 made under paragraph (1) only if an application for 

23 the grant is submitted to the Secretary and the ap24 plication is in such form, is made in such manner, 

25 and contains such agreements, assurances, and in-
41

•HR 918 IH 

1 formation as the Secretary determines to be nec2 essary to carry out this section. 

3 (5) EVALUATIONS.—

4 (A) IN GENERAL.—The Secretary, acting 

5 through the Director of the Indian Health Serv6 ice, shall, directly or through grants or con7 tracts, provide for evaluations to determine the 

8 effects of the services of patient navigators on 

9 the individuals of health disparity populations 

10 for whom the services were provided, taking 

11 into account the matters referred to in para12 graph (1)(C). 

13 (B) DISSEMINATION OF FINDINGS.—The 

14 Secretary shall as appropriate disseminate to 

15 public and private entities the findings made in 

16 evaluations under subparagraph (A). 

17 (6) COORDINATION WITH OTHER PROGRAMS.—

18 The Secretary shall coordinate the program under 

19 this subsection with the program under subsection 

20 (a) and with the program under section 417D. 

21 (c) REQUIREMENTS REGARDING FEES.—

22 (1) IN GENERAL.—A condition for the receipt 

23 of a grant under subsection (a)(1) or (b)(1) is that 

24 the program for which the grant is made have in ef25 fect—
42

•HR 918 IH 

1 (A) a schedule of fees or payments for the 

2 provision of its health care services related to 

3 the prevention and treatment of disease that is 

4 consistent with locally prevailing rates or 

5 charges and is designed to cover its reasonable 

6 costs of operation; and 

7 (B) a corresponding schedule of discounts 

8 to be applied to the payment of such fees or

9 payments, which discounts are adjusted on the 

10 basis of the ability of the patient to pay. 

11 (2) RULE OF CONSTRUCTION.—Nothing in this 

12 section shall be construed to require payment for 

13 navigation services or to require payment for health 

14 care services in cases, such as with the Indian 

15 Health Service, where care is provided free of 

16 charge. 

17 (d) MODEL.—Not later than five years after the date 

18 of the enactment of this section, the Secretary shall de19 velop a peer-reviewed model of systems for the services 

20 provided by this section. The Secretary shall update such 

21 model as may be necessary to ensure that the best prac22 tices are being utilized. 

23 (e) DURATION OF GRANT.—The period during which 

24 payments are made to an entity from a grant under sub25 section (a)(1) or (b)(1) may not exceed five years. The 
43

•HR 918 IH 

1 provision of such payments are subject to annual approval 

2 by the Secretary of the payments and subject to the avail3 ability of appropriations for the fiscal year involved to 

4 make the payments. This subsection may not be construed 

5 as establishing a limitation on the number of grants under 

6 such subsection that may be made to an entity. 

7 (f) DEFINITIONS.—For purposes of this section: 

8 (1) The term ‘‘culturally competent’’, with re9 spect to providing health-related services, means 

10 services that, in accordance with standards and 

11 measures of the Secretary, are designed to effec12 tively and efficiently respond to the cultural and lin13 guistic needs of patients. 

14 (2) The term ‘‘appropriate follow-up care’’ in15 cludes palliative and end-of-life care. 

16 (3) The term ‘‘health disparity population’’ 

17 means a population where there exists a significant 

18 disparity in the overall rate of disease incidence, 

19 morbidity, mortality, or survival rates in the popu20 lation as compared to the health status of the gen21 eral population. Such term includes—

22 (A) racial and ethnic minority groups as 

23 defined in section 1707; and 
44

•HR 918 IH 

1 (B) medically underserved groups, such as 

2 rural and low-income individuals and individ3 uals with low levels of literacy. 

4 (4)(A) The term ‘‘patient navigator’’ means an 

5 individual whose functions include—

6 (i) assisting and guiding patients with a 

7 symptom or an abnormal finding or diagnosis of 

8 cancer or other chronic disease within the 

9 health care system to accomplish the follow-up 

10 and diagnosis of an abnormal finding as well as 

11 the treatment and appropriate follow-up care of 

12 cancer or other chronic disease, including pro13 viding information about clinical trials; and 

14 (ii) identifying, anticipating, and helping 

15 patients overcome barriers within the health 

16 care system to ensure prompt diagnostic and 

17 treatment resolution of an abnormal finding of 

18 cancer or other chronic disease. 

19 (B) Such term includes representatives of the 

20 target health disparity population, such as nurses, 

21 social workers, cancer survivors, and patient advo22 cates. 

23 (g) AUTHORIZATION OF APPROPRIATIONS.—

24 (1) IN GENERAL.—
45

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1 (A) MODEL PROGRAMS.—For the purpose 

2 of carrying out subsection (a) (other than the 

3 purpose described in paragraph (2)(A)), there 

4 are authorized to be appropriated such sums as 

5 may be necessary for each of the fiscal years 

6 2004 through 2008. 

7 (B) PATIENT NAVIGATORS.—For the pur8 pose of carrying out subsection (b) (other than 

9 the purpose described in paragraph (2)(B)), 

10 there are authorized to be appropriated such 

11 sums as may be necessary for each of the fiscal 

12 years 2004 through 2008. 

13 (C) BUREAU OF PRIMARY HEALTH 13

14 CARE.—Amounts appropriated under subpara15 graph (A) or (B) shall be administered through 

16 the Bureau of Primary Health Care. 

17 (2) PROGRAMS IN RURAL AREAS.—

18 (A) MODEL PROGRAMS.—For the purpose 

19 of carrying out subsection (a) by making grants 

20 under such subsection for model programs in 

21 rural areas, there are authorized to be appro22 priated such sums as may be necessary for each 

23 of the fiscal years 2004 through 2008. 

24 (B) PATIENT NAVIGATORS.—For the pur25 pose of carrying out subsection (b) by making 
46

•HR 918 IH 

1 grants under such subsection for programs in 

2 rural areas, there are authorized to be appro3 priated such sums as may be necessary for each 

4 of the fiscal years 2004 through 2008. 

5 (C) OFFICE OF RURAL HEALTH POLICY.—

6 Amounts appropriated under subparagraph (A) 

7 or (B) shall be administered through the Office 

8 of Rural Health Policy. 

9 (3) RELATION TO OTHER AUTHORIZATIONS.—

10 Authorizations of appropriations under paragraphs 

11 (1) and (2) are in addition to other authorizations 

12 of appropriations that are available for the purposes 

13 described in such paragraphs.

Æ