103D CONGRESS

1ST SESSION H. R. 2202

AMENDMENT
In the Senate of the United States,

November 2, 1993.

Resolved, That the bill from the House of Representatives (H.R. 2202) entitled ‘‘An Act to amend the Public

Health Service Act to revise and extend the program of

grants relating to preventive health measures with respect to

breast and cervical cancer’’, do pass with the following

AMENDMENT:

Strike out all after the enacting clause and insert:

1 SECTION 1. SHORT TITLE.

2 This Act may be cited as the ‘‘Early Detection and

3 Preventive Health Act of 1993’’.

4 TITLE I—TUBERCULOSIS

5 SEC. 101. SHORT TITLE.

6 This title may be cited as the ‘‘Tuberculosis Prevention

7 and Control Amendments of 1993’’.

8 SEC. 102. FINDINGS.

9 Congress finds that—

10 (1) between 10,000,000 and 15,000,000 people in

11 the United States have been infected with tuberculosis,

12 nearly 26,000 new active cases are reported each year,

13 and over 1,700 tuberculosis-related deaths occur each

14 year;
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1 (2) the number of reported cases of tuberculosis

2 has risen from 22,201 in 1985 to 26,673 in 1992, rep3 resenting 51,000 more cases than those that would

4 have been expected since 1985;

5 (3) a recent national survey discovered that 14.4

6 percent of all active tuberculosis cases were resistant

7 to at least one drug;

8 (4) drug resistant tuberculosis strains can cost

9 more than $150,000 to treat, and even then, between

10 40 and 60 percent of the patients receiving such treat11 ment die;

12 (5) in 1992, tuberculosis cases were reported to

13 the Centers for Disease Control and Prevention by all

14 50 States, and cases resistant to one or more tuber15 culosis drugs were reported in at least 36 States, the

16 District of Columbia and Puerto Rico;

17 (6) in 1992, 27 percent of the reported cases of

18 tuberculosis occurred in foreign born persons;

19 (7) one third of the world’s population harbors

20 tuberculosis; and

21 (8) among infectious diseases tuberculosis is still

22 the number one killer in the world with an estimated

23 8,000,000 new cases each year and 2,900,000 deaths.
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1 SEC. 103. PROGRAMS OF CENTERS FOR DISEASE CONTROL

2 AND PREVENTION.

3 (a) PROVISION OF SERVICES FOR PREVENTION, CON4 TROL, AND ELIMINATION.—Section 317(j)(2) of the Public

5 Health Service Act (42 U.S.C. 247b(j)(2)) is amended—

6 (1) by inserting ‘‘(A)’’ after the paragraph des7 ignation;

8 (2) in the first sentence by striking ‘‘and’’ after

9 ‘‘1991,’’ and all that follows through ‘‘1995’’ and in10 serting the following: ‘‘, $200,000,000 for fiscal year

11 1994, and such sums as may be necessary for each of

12 the fiscal years 1995 through 1997, of which not more

13 than $50,000,000 may be made available in each such

14 fiscal year for grants under subparagraph (B)’’; and

15 (3) by adding at the end thereof the following

16 new subparagraph:

17 ‘‘(B) With respect to amounts made available to carry

18 out this subparagraph, the Secretary, acting through the

19 Director of the Centers for Disease Control and Prevention,

20 may use such amounts to make emergency grants for the

21 prevention, control, and elimination of tuberculosis. The

22 Secretary may make such a grant only if the geographic

23 area in which activities under the grant are to be carried

24 out has, relative to other areas, a substantial incidence of

25 cases of tuberculosis or a substantial rate of increase in such

26 cases.’’.
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1 (b) STATE TUBERCULOSIS PLAN.—Section 317(j) of

2 the Public Health Service Act (42 U.S.C. 247b(j)) is amend3 ed by adding at the end thereof the following new para4 graph:

5 ‘‘(3)(A) With respect to an application submitted by

6 a State for a grant under this section for the prevention,

7 control and elimination of tuberculosis, such application

8 shall contain a State plan that demonstrates that amounts

9 received under the grant will be expended in a manner that

10 ensures that tuberculosis services will be provided to those

11 at the highest risk of contracting tuberculosis, or in those

12 areas with the highest rates of tuberculosis infection.

13 ‘‘(B) Such plans shall demonstrate that the applicant

14 will work closely with and provide support to entities re15 ceiving funds under sections 329, 330, 340, 340A, or titles

16 V or XIX, and to correctional facilities, and nongovern17 mental organizations such as community-based organiza18 tions and describe how the State intends to carry out the

19 requirements of section 1924(a).

20 ‘‘(C) Such plans shall demonstrate that grant funds

21 will be used for directly observed therapy or other effective

22 interventions with respect to populations with the highest

23 rates of active infection with tuberculosis.

24 ‘‘(D) In developing the State plan, each State shall en25 sure that the entities described in subparagraph (B), the
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1 single State agency for drug and alcohol services and any

2 other State agency that has responsibility for individuals

3 in need of tuberculosis services are consulted during the

4 planning process.’’.

5 (c) RESEARCH, DEMONSTRATION PROJECTS, EDU6 CATION, AND TRAINING.—

7 (1) IN GENERAL.—Section 317(k)(2) of the Pub8 lic Health Service Act (42 U.S.C. 247b(k)(2)) is

9 amended—

10 (A) by redesignating subparagraphs (A)

11 through (D) as clauses (i) through (iv), respec12 tively;

13 (B) by inserting ‘‘(A)’’ after the paragraph

14 designation; and

15 (C) by adding at the end thereof the follow16 ing new subparagraphs:

17 ‘‘(B) In support of grants referred to in subparagraph

18 (A), the Secretary may conduct or support applied research

19 and training regarding the surveillance, diagnostic meth20 odologies, prevention, control, and treatment of tuberculosis,

21 including intramural projects and extramural projects.

22 ‘‘(C) For the purpose of carrying out subparagraphs

23 (A) and (B), there are authorized to be appropriated

24 $26,000,000 for fiscal year 1994, and such sums as may

25 be necessary for each of the fiscal years 1995 through 1997.
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1 The authorization of appropriations established in the pre2 ceding sentence is in addition to the authorization of appro3 priations established in subsection (j)(2) for carrying out

4 this paragraph.’’.

5 (2) TECHNICAL AMENDMENT.—Section 317(j)(2)

6 of the Public Health Service Act (42 U.S.C.

7 247b(j)(2)) is amended by striking the last sentence.

8 SEC. 104. RESEARCH THROUGH NATIONAL INSTITUTE OF

9 ALLERGY AND INFECTIOUS DISEASES.

10 (a) CERTAIN DUTIES.—

11 (1) IN GENERAL.—Subpart 6 of part C of title

12 IV of the Public Health Service Act (42 U.S.C. 285f)

13 is amended by inserting after section 446 the follow14 ing section:

15 ‘‘RESEARCH AND RESEARCH TRAINING REGARDING

16 TUBERCULOSIS

17 ‘‘SEC. 447. In carrying out section 446, the Director

18 of the Institute shall conduct or support basic research and

19 research training regarding the cause, diagnosis, early de20 tection, prevention and treatment of tuberculosis.’’.

21 (2) CONFORMING AMENDMENT.—Section 446 of

22 the Public Health Service Act (42 U.S.C. 285f) is

23 amended by inserting after ‘‘Diseases’’ the following:

24 ‘‘(hereafter in this subpart referred to as the ‘Insti25 tute’)’’.
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1 (b) AUTHORIZATION OF APPROPRIATIONS.—Section

2 408(a) of the Public Health Service Act (42 U.S.C. 284c(a))

3 is amended by adding at the end the following new para4 graph:

5 ‘‘(3) For the purpose of carrying out section 447

6 (relating to research on tuberculosis through the Na7 tional Institute on Allergy and Infectious Diseases),

8 there are authorized to be appropriated $46,000,000

9 for fiscal year 1994, and such sums as may be nec10 essary for each of the fiscal years 1995 through 1997.

11 The authorization of appropriations established in the

12 preceding sentence may not be construed as terminat13 ing the availability for such purpose of any other au14 thorization of appropriations.’’.

15 SEC. 105. RESEARCH THROUGH THE FOOD AND DRUG AD16 MINISTRATION.

17 Chapter V of the Food, Drug and Cosmetic Act is

18 amended by inserting after section 512 (21 U.S.C. 360b)

19 the following new section:

20 ‘‘SEC. 512A. TUBERCULOSIS DRUG AND DEVICE RESEARCH.

21 ‘‘(a) AUTHORITY.—The Commissioner of Food and

22 Drugs shall implement a tuberculosis drug and device re23 search program under which the Commissioner shall—

24 ‘‘(1) provide assistance to other Federal agencies

25 for the development of tuberculosis protocols;
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1 ‘‘(2) review and evaluate medical devices de2 signed for the diagnosis and control of airborne tuber3 culosis; and

4 ‘‘(3) conduct research concerning drugs or de5 vices to be used in diagnosing, controlling and pre6 venting tuberculosis.

7 ‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There

8 are authorized to be appropriated to carry out this section,

9 $5,000,000 for each of the fiscal years 1994 through 1997.’’.

10 SEC. 106. CONVERSION OR RENOVATION OF PUBLIC

11 HEALTH FACILITIES.

12 Section 1610 of the Public Health Service Act (42

13 U.S.C. 300r) is amended by adding at the end the following

14 subsection:

15 ‘‘(c)(1) With respect to services for the prevention, con16 trol, and elimination of tuberculosis, the Secretary may

17 make grants to public and nonprofit private entities for—

18 ‘‘(A) conversion of existing facilities into out19 patient medical facilities or facilities for long-term

20 care to provide such services for such populations;

21 ‘‘(B) renovation of inpatient facilities; or

22 ‘‘(C) renovation of facilities to provide such serv23 ices with respect to incarceration.

24 ‘‘(2) The amount of any grant under paragraph (1)

25 may not exceed 50 percent of the cost of the project for which
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1 the grant is made unless the project is located in an area

2 determined by the Secretary to be an urban or rural poverty

3 area, in which case the grant may cover up to 75 percent

4 of such costs.

5 ‘‘(3) There are authorized to be appropriated for

6 grants under paragraph (1), $25,000,000 for fiscal year

7 1994, and such sums as may be necessary for each of the

8 fiscal years 1995 through 1997.’’.

9 TITLE II—SEXUALLY

10 TRANSMITTED DISEASES

11 SEC. 201. SHORT TITLE.

12 This title may be cited as the ‘‘Sexually Transmitted

13 Diseases Amendments of 1993’’.

14 SEC. 202. EXTENSION OF PROGRAM OF GRANTS REGARDING

15 PREVENTION AND CONTROL OF SEXUALLY

16 TRANSMITTED DISEASES.

17 (a) EXTENSION OF PROGRAM.—Section 318(d)(1) of

18 the Public Health Service Act (42 U.S.C. 247c(d)(1)) is

19 amended in the first sentence—

20 (1) by striking ‘‘(b) and (c)’’ and inserting ‘‘(b)

21 and (c) of this section and section 318B’’; and

22 (2) by striking ‘‘there are authorized’’ and all

23 that follows and inserting the following: ‘‘there are

24 authorized to be appropriated $132,000,000 for fiscal
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1 year 1994, and such sums as may be necessary for

2 each of the fiscal years 1995 through 1997.’’.

3 (b) TECHNICAL CORRECTIONS.—Section 318 of the

4 Public Health Service Act (42 U.S.C. 247c) is amended—

5 (1) in subsection (b)(3), by striking ‘‘, and’’ and

6 inserting ‘‘; and’’; and

7 (2) in subsection (d)(5)—

8 (A) in subparagraph (A), by striking ‘‘form,

9 or’’ and inserting ‘‘form; or’’; and

10 (B) in subparagraph (B), by striking ‘‘pur11 poses,’’ and inserting ‘‘purposes;’’.

12 SEC. 203. EXTENSION OF PROGRAM REGARDING PREVENT13 ABLE CASES OF INFERTILITY ARISING AS RE14 SULT OF SEXUALLY TRANSMITTED DISEASES.

15 (a) TECHNICAL CORRECTION.—Section 318A of the

16 Public Health Service Act (42 U.S.C. 247c–1), as added by

17 section 304 of Public Law 102–531 (106 Stat. 3490), is

18 amended in subsection (o)(2) by striking ‘‘subsection (s)’’

19 and inserting ‘‘subsection (q)’’.

20 (b) EXTENSION OF PROGRAM.—Section 318A of the

21 Public Health Service Act (42 U.S.C. 247c–1), as added by

22 section 304 of Public Law 102–531 (106 Stat. 3490), is

23 amended—

24 (1) in subsection (q), by striking ‘‘and 1995’’

25 and inserting ‘‘through 1997’’; and
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1 (2) in subsection (r)(2), by striking ‘‘through

2 1995’’ and inserting ‘‘through 1997’’.

3 SEC. 204. SEXUALLY TRANSMITTED DISEASE ACCELERATED

4 PREVENTION CAMPAIGNS.

5 Part B of title III of the Public Health Service Act

6 is amended by inserting after section 318A (42 U.S.C. 247c7 1) the following new section:

8 ‘‘SEC. 318B. SEXUALLY TRANSMITTED DISEASE ACCELER9 ATED PREVENTION CAMPAIGNS.

10 ‘‘(a) GRANTS.—The Secretary is authorized to award

11 grants to States and political subdivisions of States for the

12 development, implementation, and evaluation of innovative,

13 interdisciplinary approaches to the prevention and control

14 of sexually transmitted diseases and their sequelae by—

15 ‘‘(1) expanding access to sexually transmitted

16 disease services through collaborations with other pub17 lic health programs and with nongovernmental part18 ners;

19 ‘‘(2) implementing community-based behavioral

20 interventions to prevent disease transmission; and

21 ‘‘(3) establishing collaborations between health

22 departments and university-based experts to strength23 en sexually transmitted diseases prevention programs.

24 ‘‘(b) APPLICATION.—To be eligible to receive a grant

25 under subsection (a), a State or political subdivision of a
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1 State, shall prepare and submit to the Secretary an appli2 cation at such time, in such manner, and containing such

3 information as the Secretary may require.

4 ‘‘(c) PRIORITY.—In awarding grants under subsection

5 (a), the Secretary shall give priority to applications that

6 seek to conduct activities with grant funds that focus on

7 the prevention of sexually transmitted diseases among

8 women and other populations that are disproportionately

9 affected by these diseases.’’.

10 TITLE III—INJURY CONTROL

11 AND VIOLENCE PREVENTION

12 SEC. 301. SHORT TITLE.

13 This title may be cited as the ‘‘Injury Control and Vio14 lence Prevention Act of 1993’’.

15 SEC. 302. FINDINGS.

16 Congress finds that—

17 (1) violence or the threat of violence has adverse

18 effects on the health and safety of Americans of all

19 ages, races, ethnicities and economic conditions;

20 (2) the majority of homicides and violent as21 saults are committed by people who have relationships

22 with their victims and are not committed by strang23 ers;

24 (3) violence is being committed in private as

25 well as public, in homes, schools, and neighborhoods;
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1 (4) interventions by law enforcement and crimi2 nal justice systems have limited ability to prevent vi3 olence;

4 (5) family and interpersonal violence represent

5 serious threats to the health and well-being of millions

6 of women in the United States;

7 (6) violence against women has serious health

8 consequences for its victims, including fatality, severe

9 trauma, repeated physical injuries, and chronic

10 stress-related disorder;

11 (7) violence against women has serious mental

12 health consequences for its victims, including sub13 stance abuse, severe psychological trauma, and sui14 cide;

15 (8) fewer than 5 percent of injured women are

16 correctly diagnosed by medical personnel as being vic17 tims of domestic violence;

18 (9) hospitals and clinics do not have a uniform

19 set of protocols for the identification and referral of

20 victims of family and interpersonal violence, or for

21 the training of health care professionals to perform

22 such functions;

23 (10) a national surveillance system for monitor24 ing the health effects of injury should be established
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1 to determine the nature and extent of family and

2 interpersonal violence in the United States; and

3 (11) the Surgeon General has identified domestic

4 violence as a public health problem to which all

5 health care providers must actively and vigorously re6 spond.

7 SEC. 303. FAMILY AND INTERPERSONAL VIOLENCE PREVEN8 TION.

9 Section 393 of the Public Health Service Act (42

10 U.S.C. 280b–2) is amended to read as follows:

11 ‘‘SEC. 393. PREVENTION OF FAMILY AND INTERPERSONAL

12 VIOLENCE.

13 ‘‘(a) RESEARCH AND TECHNICAL ASSISTANCE.—The

14 Secretary, acting through the Director of the Centers for

15 Disease Control and Prevention, may conduct research and

16 provide technical assistance to appropriate public and non17 profit private entities and to academic institutions to assist

18 such entities in performing research in, and conducting

19 training and public health programs for, the prevention of

20 injuries and deaths associated with family and inter21 personal violence.

22 ‘‘(b) GRANTS.—The Secretary, acting through the Di23 rector of the Centers for Disease Control and Prevention,

24 may award grants to States, political subdivisions of
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1 States, and any other public and nonprofit private entity

2 for—

3 ‘‘(1) the conduct of research into identifying ef4 fective strategies to prevent interpersonal violence

5 within the family and among acquaintances;

6 ‘‘(2) the development, implementation, and eval7 uation of demonstration projects for the prevention of

8 interpersonal violence within families and among ac9 quaintances;

10 ‘‘(3) the implementation of public information

11 and education programs for prevention of family and

12 interpersonal violence and to broaden public aware13 ness of the public health consequences of family and

14 interpersonal violence; and

15 ‘‘(4) the provision of education, training and

16 clinical skills improvement programs for health care

17 professionals to—

18 ‘‘(A) routinely interview and identify indi19 viduals whose medical condition or statements

20 indicate that the individuals are victims of do21 mestic violence or sexual assault; and

22 ‘‘(B) refer the individuals to entities that

23 provide services regarding such violence and as24 sault, including referrals for counseling, housing,
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1 legal services, and services of community organi2 zations.

3 ‘‘(c) INJURY SURVEILLANCE PROGRAM.—The Sec4 retary, acting through the Director of the Centers for Dis5 ease Control and Prevention, shall support the establish6 ment of national systematic surveillance of injuries, includ7 ing those caused by family and interpersonal violence.

8 ‘‘(d) DEFINITION.—As used in this section, the term

9 ‘interpersonal violence within families and acquaintances’

10 means any intentional violence, controlling, or coercive be11 havior or pattern of behavior by an individual who is cur12 rently or who was previously, in an intimate or acquaint13 ance relationship with the victim. Such behavior may occur

14 at any stage of the lifecycle and may encompass single acts

15 or a syndrome of actual or threatened physical injury, sex16 ual assault, rape, psychological abuse, or neglect. Such term

17 includes behavior which currently may be described as

18 ‘child neglect’, ‘child abuse’, ‘spousal abuse’, ‘domestic vio19 lence’, ‘woman battering’, ‘partner abuse’, ‘elder abuse’, and

20 ‘date rape’.

21 ‘‘(e) APPLICATION.—To be eligible to receive assistance

22 under subsection (a) or (b), an entity shall prepare and

23 submit to the Secretary an application at such time, in

24 such manner, and containing such information as the Sec25 retary may require.’’.
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1 SEC. 304. ADVISORY COMMITTEE; REPORTS.

2 Part J of title III of the Public Health Service Act

3 (as amended by Public Law 103-43) is amended by insert4 ing after section 393 (42 U.S.C. 280b-2) the following new

5 section:

6 ‘‘SEC. 393A. GENERAL PROVISIONS.

7 ‘‘(a) ADVISORY COMMITTEE.—The Secretary, acting

8 through the Director of the Centers for Disease Control and

9 Prevention, shall establish an advisory committee to advise

10 the Secretary and such Director with respect to the preven11 tion and control of injuries.

12 ‘‘(b) REPORT.—Not later than February 1 of 1996 and

13 of every second year thereafter, the Secretary, acting

14 through the Director of the Centers for Disease Control and

15 Prevention, shall submit to the Committee on Energy and

16 Commerce of the House of Representatives, and to the Com17 mittee on Labor and Human Resources of the Senate, a

18 report describing the activities carried out under this part

19 during the preceding 2 fiscal years. Such report shall in20 clude a description of such activities that were carried out

21 with respect to domestic violence and sexual assault and

22 with respect to rural areas.’’.

23 SEC. 305. TECHNICAL CORRECTIONS.

24 (a) TERMINOLOGY.—Part J of title III of the Public

25 Health Service Act (42 U.S.C. 280b et seq.) (as amended

26 by Public Law 103-43) is amended—
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1 (1) in the heading for such part, by striking ‘‘IN2 JURY CONTROL’’ and inserting ‘‘PREVENTION AND

3 CONTROL OF INJURIES’’; and

4 (2) in section 392—

5 (A) in the heading for such section, by in6 serting ‘‘PREVENTION AND’’ before ‘‘CONTROL AC7 TIVITIES’’;

8 (B) in subsection (a)(1), by inserting ‘‘and

9 control’’ after ‘‘prevention’’; and

10 (C) in subsection (b)(1), by striking ‘‘inju11 ries and injury control’’ and inserting ‘‘the pre12 vention and control of injuries’’.

13 (b) PROVISIONS RELATING TO PUBLIC LAW 102–

14 531.—Part J of title III of the Public Health Service Act

15 (42 U.S.C. 280b et seq.) (as amended by Public Law 103–

16 43 (106 Stat. 3482), is amended—

17 (1) in section 392(b)(2), by striking ‘‘to promote

18 injury control’’ and all that follows and inserting ‘‘to

19 promote activities regarding the prevention and con20 trol of injuries; and’’; and

21 (2) in section 391(b), by adding at the end the

22 following sentence: ‘‘In carrying out the preceding

23 sentence, the Secretary shall disseminate such infor24 mation to the public, including through elementary

25 and secondary schools.’’.
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1 SEC. 306. AUTHORIZATION OF APPROPRIATIONS.

2 Section 394 of the Public Health Service Act (42

3 U.S.C. 280b–3) is amended—

4 (1) by striking ‘‘391 and 392’’ and inserting

5 ‘‘391, 392, and 393’’; and

6 (2) by striking ‘‘$10,000,000’’ and all that fol7 lows through the period and inserting ‘‘$60,000,000’’

8 for fiscal year 1994, and such sums as may be nec9 essary for each of the fiscal years 1995 through

10 1997.’’.

11 TITLE IV—BREAST AND CER12 VICAL CANCER AMENDMENTS

13 SEC. 401. SHORT TITLE.

14 This title may be cited as the ‘‘Breast and Cervical

15 Cancer Amendments of 1993’’.

16 SEC. 402. REVISIONS IN PROGRAM OF STATE GRANTS RE17 GARDING BREAST AND CERVICAL CANCER.

18 (a) LIMITED AUTHORITY REGARDING FOR-PROFIT

19 ENTITIES.—

20 (1) IN GENERAL.—Section 1501(b) of the Public

21 Health Service Act (42 U.S.C. 300k(b)) is amended—

22 (A) by striking ‘‘STATES.—A State’’ and all

23 that follows through ‘‘may expend’’ and inserting

24 the following: ‘‘STATES.—
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1 ‘‘(1) IN GENERAL.—A State receiving a grant

2 under subsection (a) may, subject to paragraphs (2)

3 and (3), expend’’; and

4 (B) by adding at the end the following

5 paragraphs:

6 ‘‘(2) LIMITED AUTHORITY REGARDING OTHER

7 ENTITIES.—In addition to the authority established

8 in paragraph (1) for a State with respect to grants

9 and contracts, the State may provide for screenings

10 under subsection (a)(1) through entering into con11 tracts with private entities.

12 ‘‘(3) PAYMENTS FOR SCREENINGS.—The amount

13 paid by a State to an entity under this subsection for

14 a screening procedure under subsection (a)(1) may

15 not exceed the amount that would be paid under part

16 B of title XVIII of the Social Security Act if payment

17 were made under such part for furnishing the proce18 dure to a woman enrolled under such part.’’.

19 (2) CONFORMING AMENDMENT.—Section 1505(3)

20 of the Public Health Service Act (42 U.S.C. 300n21 1(3)) is amended by inserting before the semicolon the

22 following: ‘‘(and additionally, in the case of services

23 and activities under section 1501(a)(1), with any

24 similar services or activities of private entities)’’.
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1 (b) SPECIAL CONSIDERATION FOR GRANTS.—Section

2 1501 of the Public Health Service Act (42 U.S.C. 300k) is

3 amended by adding at the end thereof the following new

4 subsection:

5 ‘‘(c) SPECIAL CONSIDERATION.—In making grants

6 under subsection (a) after the date of enactment of this sub7 section, the Secretary shall give special consideration to

8 projects that have been peer reviewed and approved and

9 that involve areas that—

10 ‘‘(1) have high cervical or breast cancer mortal11 ity rates; or

12 ‘‘(2) have a high incidence of cervical or breast

13 cancer.’’.

14 (c) EXEMPTION FROM MATCHING REQUIREMENTS.—

15 Section 1502(b)(1) of the Public Health Service Act (42

16 U.S.C. 300l(b)(1)) is amended to read as follows:

17 ‘‘(1) TYPES OF CONTRIBUTIONS.—

18 ‘‘(A) GENERAL RULE.—Non-Federal con19 tributions required in subsection (a) may be in

20 cash or in kind, fairly evaluated, including

21 equipment or services (and excluding indirect or

22 overhead costs). Amounts provided by the Fed23 eral Government, or services assisted or sub24 sidized to any significant extent by the Federal

25 Government, may not be included in determin-
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1 ing the amount of such non-Federal contribu2 tions.

3 ‘‘(B) DONATED TREATMENT SERVICES.—In

4 meeting the non-Federal contribution require5 ment of this section, the State involved—

6 ‘‘(i) may, with respect to a grant

7 awarded for a program under paragraph

8 (1) or (2) of section 1501(a), use the value

9 of any donated outreach services associated

10 with the delivery of breast and cervical can11 cer screenings conducted under the program,

12 and the value of any additional donated

13 breast or cervical cancer diagnostic or treat14 ment services provided subsequent to the

15 screening conducted under the program; and

16 ‘‘(ii) may not, with respect to a grant

17 awarded for a program under paragraph

18 (3), (4), (5) or (6) of section 1501(a), in19 clude the value of any donated breast or cer20 vical cancer outreach, diagnosis, or treat21 ment services.’’.

22 (d) REQUIREMENTS WITH RESPECT TO TYPE AND

23 QUALITY OF SERVICES.—

24 (1) IN GENERAL.—Section 1503 of the Public

25 Health Service Act (42 U.S.C. 300m) is amended—
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1 (A) in subsection (a)—

2 (i) in paragraph (1), to read as fol3 lows:

4 ‘‘(1) to ensure that, after a limited period of time

5 and thereafter throughout the period during which

6 amounts are received pursuant to the grant, except for

7 the period of the first year when a 50 percent mini8 mum shall apply, not less than 60 percent of the

9 grant is expended to provide each of the services or

10 activities described in paragraphs (1) and (2) of sec11 tion 1501(a), including making available screening

12 procedures for both breast and cervical cancers;’’; and

13 (ii) in paragraph (4), to read as fol14 lows:

15 ‘‘(4) to ensure that not more than 40 percent of

16 the grant is expended to provide the services or activi17 ties described in paragraphs (3) through (6) of section

18 1501(a), except in the case of the first year during

19 which the maximum expended for these purposes shall

20 not exceed 50 percent of the grant.’’; and

21 (B) by striking subsections (c) through (e)

22 and inserting the following:

23 ‘‘(c) QUALITY ASSURANCE REGARDING SCREENING

24 PROCEDURES.—The Secretary may not make a grant

25 under section 1501 unless the State involved agrees that the
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1 State will, in accordance with applicable law, assure the

2 quality of screening procedures conducted pursuant to such

3 section.’’.

4 (2) TRANSITION RULE REGARDING

5 MAMMOGRAPHIES.—With respect to the screening pro6 cedure for breast cancer known as a mammography,

7 the requirements in effect on the day before the date

8 of the enactment of this Act under section 1503(c) of

9 the Public Health Service Act remain in effect (for an

10 individual or facility conducting such procedures

11 pursuant to a grant to a State under section 1501 of

12 such Act) until there is in effect for the facility a cer13 tificate (or provisional certificate) issued under sec14 tion 354 of such Act.

15 (e) STATEWIDE PROVISION OF SERVICES.—Section

16 1504(c) of the Public Health Service Act (42 U.S.C.

17 300n(c)) is amended by adding at the end the following

18 paragraph:

19 ‘‘(3) GRANTS TO TRIBES AND TRIBAL ORGANIZA20 TIONS.—

21 ‘‘(A) The Secretary, acting through the Di22 rector of the Centers for Disease Control and

23 Prevention, may make grants to tribes and tribal

24 organizations (as such terms are used in para25 graph (1)) for the purpose of carrying out pro-
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1 grams described in section 1501(a). This title ap2 plies to such a grant (in relation to the jurisdic3 tion of the tribe or organization) to the same ex4 tent and in the same manner as such title ap5 plies to a grant to a State under section 1501

6 (in relation to the jurisdiction of the State).

7 ‘‘(B) If a tribe or tribal organization is re8 ceiving a grant under subparagraph (A) and the

9 State in which the tribe or organization is lo10 cated is receiving a grant under section 1501, the

11 requirement established in paragraph (1) for the

12 State regarding the tribe or organization is

13 deemed to have been waived under paragraph

14 (2).’’.

15 (f) EVALUATIONS AND REPORTS.—Section 1508 of the

16 Public Health Service Act (42 U.S.C. 300n–4) is amend17 ed—

18 (1) in subsection (a), by adding at the end the

19 following sentence: ‘‘Such evaluations shall include

20 evaluations of the extent to which States carrying out

21 such programs are in compliance with section

22 1501(a)(2) and with section 1504(c).’’; and

23 (2) in subsection (b), by inserting before the pe24 riod the following: ‘‘, including recommendations re-
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1 garding compliance by the States with section

2 1501(a)(2) and with section 1504(c)’’.

3 (g) TECHNICAL CORRECTIONS.—Title XV of the Public

4 Health Service Act (42 U.S.C. 300k et seq.) is amended—

5 (1) in section 1501(a), in the matter preceding

6 paragraph (1), by striking ‘‘Control,’’ and inserting

7 ‘‘Control and Prevention,’’; and

8 (2) in section 1505—

9 (A) in paragraph (3), by striking

10 ‘‘nonprivate’’ and inserting ‘‘nonprofit private’’;

11 and

12 (B) in paragraph (4), by inserting ‘‘will’’

13 before ‘‘be used’’.

14 SEC. 403. ESTABLISHMENT OF DEMONSTRATION PROGRAM

15 OF GRANTS FOR ADDITIONAL PREVENTIVE

16 HEALTH SERVICES FOR WOMEN.

17 (a) IN GENERAL.—Title XV of the Public Health Serv18 ice Act (42 U.S.C. 300k et seq.) is amended—

19 (1) by redesignating section 1509 as section

20 1510; and

21 (2) by inserting after section 1508 the following

22 section:
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1 ‘‘SEC. 1509. SUPPLEMENTAL GRANTS FOR ADDITIONAL PRE2 VENTIVE HEALTH SERVICES.

3 ‘‘(a) DEMONSTRATION PROJECTS.—In the case of

4 States receiving grants under section 1501, the Secretary,

5 acting through the Director of the Centers for Disease Con6 trol and Prevention, may make grants to not more than

7 3 such States to carry out demonstration projects for the

8 purpose of—

9 ‘‘(1) providing preventive health services in ad10 dition to the services authorized in such section, in11 cluding screenings regarding blood pressure and cho12 lesterol, and including health education;

13 ‘‘(2) providing appropriate referrals for medical

14 treatment of women receiving services pursuant to

15 paragraph (1) and ensuring, to the extent practicable,

16 the provision of appropriate follow-up services; and

17 ‘‘(3) evaluating activities conducted under para18 graphs (1) and (2) through appropriate surveillance

19 or program-monitoring activities.

20 ‘‘(b) STATUS AS PARTICIPANT IN PROGRAM REGARD21 ING BREAST AND CERVICAL CANCER.—The Secretary may

22 not make a grant under subsection (a) unless the State in23 volved agrees that services under the grant will be provided

24 only through entities that are screening women for breast

25 or cervical cancer pursuant to a grant under section 1501.
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1 ‘‘(c) APPLICABILITY OF PROVISIONS OF GENERAL PRO2 GRAM.—This title applies to a grant under subsection (a)

3 to the same extent and in the same manner as such title

4 applies to a grant under section 1501.

5 ‘‘(d) FUNDING.—

6 ‘‘(1) IN GENERAL.—Subject to paragraph (2), for

7 the purpose of carrying out this section, there are au8 thorized to be appropriated $3,000,000 for fiscal year

9 1994, and such sums as may be necessary for each of

10 the fiscal years 1995 through 1997.

11 ‘‘(2) LIMITATION REGARDING FUNDING WITH RE12 SPECT TO BREAST AND CERVICAL CANCER.—The au13 thorization of appropriations established in para14 graph (1) is not effective for a fiscal year unless the

15 amount appropriated under section 1510(a) for the

16 fiscal year equals or exceeds $100,000,000.’’.

17 (b) CONFORMING AMENDMENT.—Section 1510(a) of

18 the Public Health Service Act, as redesignated by subsection

19 (a)(1) of this section, is amended in the heading for the

20 section by striking ‘‘FUNDING.’’ and inserting ‘‘FUNDING

21 FOR GENERAL PROGRAM.’’.

22 SEC. 404. FUNDING FOR GENERAL PROGRAM.

23 Section 1510(a) of the Public Health Service Act (as

24 amended by section 403(a)(2)) is amended—

25 (1) by striking ‘‘and’’ after ‘‘1991,’’; and
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1 (2) by inserting before the period the following:

2 ‘‘, $200,000,000 for fiscal year 1994, and such sums

3 as may be necessary for each of the fiscal years 1995

4 through 1997’’.

5 TITLE V—MISCELLANEOUS

6 PROVISIONS

7 SEC. 501. EVALUATIONS.

8 Section 2711 of the Public Health Service Act (42

9 U.S.C. 300aaa-10) is amended to read as follows:

10 ‘‘EVALUATION OF PROGRAMS

11 ‘‘SEC. 2711. (a) IN GENERAL.—Such portion as the

12 Secretary shall determine, but not less than .2 percent nor

13 more than 1 percent, of any amounts appropriated for pro14 grams authorized under this Act for any fiscal year begin15 ning after September 20, 1993, shall be made available for

16 the evaluation (directly, or by grants of contracts) of the

17 implementation and effectiveness of such programs.

18 ‘‘(b) REPORT ON EVALUATIONS.—

19 ‘‘(1) IN GENERAL.—To provide information for

20 legislative deliberations concerning Federal health

21 programs, the Secretary shall, not later than January

22 1 of each year, prepare and submit to the Committee

23 on Labor and Human Resources of the Senate and

24 the Committee on Energy and Commerce of the House

25 of Representatives a report that identifies and synthe26 sizes the findings of the evaluations conducted under
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1 subsection (a) by program area. Such report shall

2 also include the plans of the Secretary for the subse3 quent year’s evaluations, including programs and

4 issue areas.

5 ‘‘(2) FIVE YEAR REVIEW.—A report submitted

6 under paragraph (1) shall contain a description of

7 the findings of the Secretary with respect to evalua8 tions conducted under subsection (a) or other provi9 sions of law, during the 5-year period prior to the

10 year for which the report is being submitted. Such de11 scription shall provide the Committees referred to in

12 paragraph (1) with information concerning program

13 changes that the Secretary intends to implement in

14 response to such findings in order to improve the

15 health of the American people and their receipt of

16 needed and effective public health services.’’.

17 SEC. 502. FEDERAL BENEFITS FOR OVERSEAS ASSIGNEES.

18 Section 307 of the Public Health Service Act (42

19 U.S.C. 242l) is amended by adding at the end thereof the

20 following new subsection:

21 ‘‘(c) The Secretary may provide to personnel ap22 pointed or assigned by the Secretary to serve abroad, allow23 ances and benefits similar to those provided under chapter

24 9 of title I of the Foreign Service Act of 1990 (22 U.S.C.

25 4081 et seq.). Leaves of absence for personnel under this
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1 subsection shall be on the same basis as that provided under

2 subchapter I of chapter 63 of title 5, United States Code

3 to individuals serving in the Foreign Service.’’.

4 SEC. 503. LOAN REPAYMENT PROGRAM.

5 Part J of title III of the Public Health Service Act

6 (as amended by section 2008 of Public Law 103-43) is

7 amended by inserting after section 393A (as added by sec8 tion 304) the following new section:

9 ‘‘SEC. 393B. LOAN REPAYMENT PROGRAM.

10 ‘‘(a) IN GENERAL.—

11 ‘‘(1) AUTHORITY.—Subject to paragraph (2), the

12 Secretary may carry out a program of entering into

13 contracts with appropriately qualified health profes14 sionals under which such health professionals agree to

15 conduct prevention activities, as employees of the Cen16 ters for Disease Control and Prevention and the Agen17 cy for Toxic Substances and Disease Registry, in con18 sideration of the Federal Government agreeing to

19 repay, for each year of such service, not more than

20 $20,000 of the principal and interest of the edu21 cational loans of such health professionals.

22 ‘‘(2) LIMITATION.—The Secretary may not enter

23 into an agreement with a health professional pursu24 ant to paragraph (1) unless such professional—
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1 ‘‘(A) has a substantial amount of edu2 cational loans relative to income; and

3 ‘‘(B) agrees to serve as an employee of the

4 Centers for Disease Control and Prevention or

5 the Agency for Toxic Substances and Disease

6 Registry for purposes of paragraph (1) for a pe7 riod of not less than 3 years.

8 ‘‘(b) APPLICABILITY OF CERTAIN PROVISIONS.—With

9 respect to the National Health Service Corps Loan Repay10 ment Program established in subpart III of part D of title

11 III of this Act, the provisions of such subpart shall, except

12 as inconsistent with subsection (a), apply to the program

13 established in this section in the same manner and to the

14 same extent as such provisions apply to the National Health

15 Service Corps Loan Repayment Program.

16 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—For the

17 purpose of carrying out this section, there are authorized

18 to be appropriated $500,000 for each of the fiscal years

19 1994 through 1997.’’.

20 SEC. 504. ESTABLISHMENT OF REQUIREMENT OF BIENNIAL

21 REPORT ON NUTRITION AND HEALTH.

22 Title XVII of the Public Health Service Act (42 U.S.C.

23 300u et seq.), as amended by section 302 of Public Law

24 102-531 (106 Stat. 3483), is amended by adding at the end

25 the following section:
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1 ‘‘BIENNIAL REPORT REGARDING NUTRITION AND HEALTH

2 ‘‘SEC. 1709. (a) BIENNIAL REPORT.—The Secretary

3 shall require the Surgeon General of the Public Health Serv4 ice to prepare biennial reports on the relationship between

5 nutrition and health. Such reports may, with respect to

6 such relationship, include any recommendations of the Sec7 retary and the Surgeon General regarding the public health.

8 ‘‘(b) SUBMISSION TO CONGRESS.—The Secretary shall

9 ensure that, not later than February 1 of 1995 and of every

10 second year thereafter, a report under subsection (a) is sub11 mitted to the Committee on Energy and Commerce of the

12 House of Representatives and the Committee on Labor and

13 Human Resources of the Senate.

14 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—For the

15 purpose of carrying out this section, there are authorized

16 to be appropriated such sums as may be necessary for each

17 of the fiscal years 1994 through 1997.’’.

18 SEC. 505. ALIGNMENT OF CURRENT CENTERS FOR DISEASE

19 CONTROL AND PREVENTION REAUTHORIZA20 TION SCHEDULE.

21 (a) PROSTATE CANCER PREVENTION.—Section

22 317D((l)(1) of such Act (42 U.S.C. 247b-5(l)(1)) is amended

23 by striking ‘‘through 1996’’ and inserting ‘‘through 1997’’.

24 (b) CANCER REGISTRIES.—Section 399L(a) of such

25 Act (42 U.S.C. 280e-4(a)) (as amended by section 2003(1)
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1 of Public Law 103-43) is amended by striking ‘‘through

2 1996’’ and inserting ‘‘through 1997’’.

3 (c) HEALTH PROMOTION AND DISEASE PREVENTION

4 RESEARCH AND DEMONSTRATION CENTERS.—Section

5 1706(e) of such Act (42 U.S.C. 300u-5(e)) is amended by

6 striking ‘‘through 1996’’ and inserting ‘‘through 1997’’.

7 (d) SENSE OF CONGRESS.—It is the sense of Congress

8 that, beginning on the date of enactment of this Act and

9 continuing through fiscal year 1997, all Acts regarding the

10 authorization or reauthorization of Centers for Disease Con11 trol and Prevention programs should be authorized only

12 through fiscal year 1997. Beginning in fiscal year 1997,

13 Congress should reauthorize the Centers for Disease Control

14 and Prevention and its programs in one comprehensive Act.

15 After fiscal year 1997, reauthorization of such Centers and

16 its programs should occur on a regular cyclical basis.

17 SEC. 506. BREAST AND CERVICAL CANCER INFORMATION.

18 Title XXVII of the Public Health Service Act (42

19 U.S.C. 300aaa et seq.) is amended by adding at the end

20 the following new section:

21 ‘‘SEC. 2715. BREAST AND CERVICAL CANCER INFORMATION.

22 ‘‘(a) IN GENERAL.—Each of the entities referred to in

23 subsection (b) shall make available, to such individuals as

24 the entities determine appropriate, information (in a cul25 turally competent manner) concerning breast and cervical
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1 cancer, including if appropriate, information on the need

2 for breast self-examinations and the skills for such self-ex3 aminations, and shall refer such clients as the entities deter4 mine appropriate for breast and cervical cancer screening,

5 treatment or other services.

6 ‘‘(b) ENTITIES.—The entities referred to in subsection

7 (a) are—

8 ‘‘(1) a migrant health center receiving assistance

9 under section 329;

10 ‘‘(2) a community health center receiving assist11 ance under section 330;

12 ‘‘(3) an entity receiving assistance under section

13 340;

14 ‘‘(4) an alcohol or drug treatment entity or men15 tal health entity receiving assistance under title V or

16 title XIX;

17 ‘‘(5) a family planning project described in sec18 tion 1001;

19 ‘‘(6) an entity receiving assistance under title

20 XXVI;

21 ‘‘(7) a clinic that treats sexually transmitted dis22 eases and is authorized under section 318;

23 ‘‘(8) an entity receiving funds to provide pri24 mary health services to residents of public housing

25 under section 340A;
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1 ‘‘(9) a non-Federal entity authorized under the

2 Indian Self-Determination Act; and

3 ‘‘(10) a tuberculosis clinic receiving assistance

4 under section 317(j)(2) or 317(k)(2).’’.

5 SEC. 507. PAYMENT OF JUDGMENTS.

6 Section 224(k)(2) of the Public Health Service Act (42

7 U.S.C. 233(k)(2)), as added by section 4 of the Federally

8 Supported Health Centers Assistance Act of 1992, is amend9 ed by adding at the end thereof the following new sentence:

10 ‘‘Appropriations for purposes of this paragraph shall be

11 made separate from appropriations made for purposes of

12 sections 329, 330, 340 and 340A.’’.

13 SEC. 508. INTERIM FINAL REGULATIONS.

14 The Secretary of Health and Human Services is au15 thorized to issue interim final regulations—

16 (1) under which the Secretary may approve ac17 creditation bodies under section 354(e) of the Public

18 Health Service Act (42 U.S.C. 263b(e)); and

19 (2) establishing quality standards under section

20 354(f) of the Public Health Service Act (42 U.S.C.

21 263b(f)).

Attest:

Secretary.
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