IB 
Union Calendar No. 447 
108TH CONGRESS 
2D SESSION 
H. R. 918 
[Report No. 108–727, Part I] 
To authorize the Health Resources and Services Administration, the National 
Cancer Institute, and the Indian Health Service to make grants for 
model programs to provide to individuals of health disparity populations 
prevention, early detection, treatment, and appropriate follow-up care 
services for cancer and chronic diseases, and to make grants regarding 
patient navigators to assist individuals of health disparity populations 
in receiving such services. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 26, 2003 
Mr. MENENDEZ (for himself, Ms. PRYCE of Ohio, Mr. GREEN of Texas, Ms. 
ROS-LEHTINEN, Mr. THOMPSON of Mississippi, Mr. LINCOLN DIAZ- 
BALART 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 re-
ferred 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 with-
in the jurisdiction of the committee concerned 
OCTOBER 5, 2004 
Additional sponsors: Ms. GINNY BROWN-WAITE of Florida, Mr. FROST, Mr. 
FORD, Mr. NORWOOD, Mr. KILDEE, Mr. RENZI, Mr. RANGEL, Mr. 
RAMSTAD, Ms. KILPATRICK, Mr. PICKERING, Mr. CAPUANO, Mrs. 
CAPITO, Mr. MATSUI, Mr. FLETCHER, Mr. ISRAEL, Mr. GRIJALVA, Mr. 
GREEN of Wisconsin, Mr. OBERSTAR, Mr. LAHOOD, Mr. MEEHAN, Mr. 
ROGERS of Michigan, Mr. STUPAK, Mr. PASCRELL, Mr. HOLT, Ms. 
MCCOLLUM, Ms. BALDWIN, Mr. PAYNE, Mr. WHITFIELD, Mr. KIND, Mr. 
GOSS, Mr. PETERSON of Minnesota, Mr. BOOZMAN, Mrs. MCCARTHY of 
New York, Mr. UPTON, Mr. BURNS, Mr. KING of New York, Mr. 
CUNNINGHAM, Mrs. MYRICK, Mr. TIBERI, Mr. SMITH of Washington, Mr. 
COX, Mr. WICKER, Mr. CASTLE, Mr. LATOURETTE, Ms. HOOLEY of Or-
egon, Mrs. EMERSON, Mr. KIRK, Mr. KLECZKA, Mr. SHIMKUS, Mr. 
WELLER, Mr. SIMMONS, Mr. NETHERCUTT, Mr. RYAN of Wisconsin, Mr. 
ROSS, Mr. COSTELLO, Mr. WALSH, Mr. ROGERS of Kentucky, Mr. SMITH 
of New Jersey, Mr. CAMP, Mrs. JONES of Ohio, Mr. BOSWELL, Mr. BAR-
TON of Texas, Mr. GILLMOR, Mr. HALL, Mr. MARSHALL, Mr. SESSIONS, 
Mr. BASS, Mr. JOHNSON of Illinois, Mr. TERRY, Mr. FERGUSON, Mr. 
MCDERMOTT, Mr. HAYWORTH, Mr. LEACH, Mr. EHLERS, Mr. KING-
STON, Mr. BRADLEY of New Hampshire, Mr. KENNEDY of Minnesota, 
Mr. GRAVES, Mr. SCHROCK, Mr. CLAY, Mrs. JO ANN DAVIS of Virginia, 
Ms. JACKSON-LEE of Texas, Mr. BISHOP of Georgia, Mr. HYDE, Mr. 
MOORE, Mr. ISSA, Mr. WAXMAN, Mr. KLINE, Mr. GREENWOOD, Mr. 
DAVIS of Florida, Mr. SCOTT of Virginia, Mr. CRAMER, Mr. FILNER, Mr. 
MCHUGH, Mr. ANDREWS, Mr. REYES, Mr. MICHAUD, Ms. BERKLEY, Ms. 
MCCARTHY of Missouri, Mr. TOWNS, Mr. CUMMINGS, Mrs. KELLY, Mr. 
BELL, Mr. PLATTS, Mr. ALLEN, Mr. KENNEDY of Rhode Island, Mr. 
BISHOP of Utah, Mr. SHAYS, Mr. VITTER, Mr. CARSON of Oklahoma, 
Mr. WYNN, Ms. HERSETH, Mr. WALDEN of Oregon, Mr. ROTHMAN, Mr. 
DEAL of Georgia, Mr. GONZALEZ, and Mr. MCNULTY 
OCTOBER 5, 2004 
Reported from the Committee on Energy and Commerce with amendments 
[Strike out all after the enacting clause and insert the part printed in italic] 
OCTOBER 5, 2004 
Referral to the Committee on Resources extended for a period ending not later 
than October 5, 2004 
OCTOBER 5, 2004 
Committee on Resources discharged; committed to the Committee of the 
Whole House on the State of the Union and ordered to be printed 
[For text of introduced bill, see copy of bill as introduced on February 26, 2003] 
A BILL 
To authorize the Health Resources and Services Administra-
tion, the National Cancer Institute, and the Indian 
Health Service to make grants for model programs to 
provide to individuals of health disparity populations pre-
vention, early detection, treatment, and appropriate fol-
low-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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Patient Navigator Out-
reach and Chronic Disease Prevention Act of 2004’’. 
SEC. 2. PATIENT NAVIGATOR GRANTS. 
Subpart V of part D of title III of the Public Health 
Service Act (42 U.S.C. 256) is amended by adding at the 
end the following: 
‘‘SEC. 340A. PATIENT NAVIGATOR GRANTS. 
‘‘(a) GRANTS.—The Secretary, acting through the Ad-
ministrator of the Health Resources and Services Adminis-
tration, may make grants to eligible entities for the develop-
ment and operation of demonstration programs to provide 
patient navigator services to improve health care outcomes. 
The Secretary shall coordinate with, and ensure the partici-
pation of, the Indian Health Service, the National Cancer 
Institute, the Office of Rural Health Policy, and such other 
offices and agencies as deemed appropriate by the Sec-
retary, regarding the design and evaluation of the dem-
onstration programs. 
‘‘(b) USE OF FUNDS.—A condition on the receipt of 
a grant under this section is that the grantee agree to use 
the grant to recruit, assign, train, and employ patient navi-
gators who have direct knowledge of the communities they 
serve to facilitate the care of individuals, including by per-
forming each of the following duties: 
‘‘(1) Acting as contacts, including by assisting 
in the coordination of health care services and pro-
vider referrals, for individuals who are seeking pre-
vention or early detection services for, or who fol-
lowing a screening or early detection service are 
found to have a symptom, abnormal finding, or diag-
nosis of, cancer or other chronic disease. 
‘‘(2) Facilitating the involvement of community 
organizations providing assistance to individuals who 
are at risk for or who have cancer or other chronic 
diseases to receive better access to high-quality health 
care services (such as by creating partnerships with 
patient advocacy groups, charities, health care cen-
ters, community hospice centers, other health care 
providers, or other organizations in the targeted com-
munity). 
‘‘(3) Notifying individuals of clinical trials and 
facilitating enrollment in these trials if requested and 
eligible. 
‘‘(4) Anticipating, identifying, and helping pa-
tients to overcome barriers within the health care sys-
tem to ensure prompt diagnostic and treatment reso-
lution of an abnormal finding of cancer or other 
chronic disease. 
‘‘(5) Coordinating with the relevant health insur-
ance ombudsman programs to provide information to 
individuals who are at risk for or who have cancer 
or other chronic diseases about health coverage, in-
cluding private insurance, health care savings ac-
counts, and other publicly funded programs (such as 
Medicare, Medicaid, and the State children’s health 
insurance program). 
‘‘(6) Conducting ongoing outreach to health dis-
parity populations, including the uninsured, rural 
populations, and other medically underserved popu-
lations, in addition to assisting other individuals who 
are at risk for or who have cancer or other chronic 
diseases to seek preventative care. 
‘‘(c) GRANT PERIOD.— 
‘‘(1) IN GENERAL.—Subject to paragraphs (2) 
and (3), the Secretary may award grants under this 
section for periods of not more than 3 years. 
‘‘(2) EXTENSIONS.—Subject to paragraph (3), 
the Secretary may extend the period of a grant under 
this section, except that— 
‘‘(A) each such extension shall be for a pe-
riod of not more than 1 year; and
‘‘(B) the Secretary may make not more 
than 4 such extensions with respect to any grant. 
‘‘(3) END OF GRANT PERIOD.—In carrying out 
this section, the Secretary may not authorize any 
grant period ending after September 30, 2010. 
‘‘(d) APPLICATION.— 
‘‘(1) IN GENERAL.—To seek a grant under this 
section, an eligible entity shall submit an application 
to the Secretary in such form, in such manner, and 
containing such information as the Secretary may re-
quire. 
‘‘(2) CONTENTS.—At a minimum, the Secretary 
shall require each such application to outline how the 
eligible entity will establish baseline measures and 
benchmarks that meet the Secretary’s requirements to 
evaluate program outcomes. 
‘‘(e) UNIFORM BASELINE MEASURES.—The Secretary 
shall establish uniform baseline measures in order to prop-
erly evaluate the impact of the demonstration projects under 
this section. 
‘‘(f) PREFERENCE.—In making grants under this sec-
tion, the Secretary shall give preference to eligible entities 
that demonstrate in their applications plans to utilize pa-
tient navigator services to overcome significant barriers in
order to improve health care outcomes in their respective 
communities. 
‘‘(g) COORDINATION WITH OTHER PROGRAMS.—The 
Secretary shall ensure coordination of the demonstration 
grant program under this section with existing authorized 
programs in order to facilitate access to high-quality health 
care services. 
‘‘(h) STUDY; REPORTS.— 
‘‘(1) FINAL REPORT BY SECRETARY.—Not later 
than 6 months after the completion of the demonstra-
tion grant program under this section, the Secretary 
shall conduct a study of the results of the program 
and submit to the Congress a report on such results 
that includes the following: 
‘‘(A) An evaluation of the program out-
comes, including— 
‘‘(i) quantitative analysis of baseline 
and benchmark measures; and 
‘‘(ii) aggregate information about the 
patients served and program activities. 
‘‘(B) Recommendations on whether patient 
navigator programs could be used to improve pa-
tient outcomes in other public health areas. 
‘‘(2) INTERIM
REPORTS
BY
SECRETARY.—The 
Secretary may provide interim reports to the Con-
gress on the demonstration grant program under this 
section at such intervals as the Secretary determines 
to be appropriate. 
‘‘(3) INTERIM REPORTS BY GRANTEES.—The Sec-
retary may require grant recipients under this section 
to submit interim reports on grant program outcomes. 
‘‘(i) RULE OF CONSTRUCTION.—This section shall not 
be construed to authorize funding for the delivery of health 
care services (other than the patient navigator duties listed 
in subsection (b)). 
‘‘(j) DEFINITIONS.—In this section: 
‘‘(1) The term ‘eligible entity’ means a public or 
nonprofit private health center (including a Federally 
qualified health center (as that term is defined in sec-
tion 1861(aa)(4) of the Social Security Act)), a health 
facility operated by or pursuant to a contract with 
the Indian Health Service, a hospital, a cancer cen-
ter, a rural health clinic, an academic health center, 
or a nonprofit entity that enters into a partnership 
or coordinates referrals with such a center, clinic, fa-
cility, or hospital to provide patient navigator serv-
ices. 
‘‘(2) The term ‘health disparity population’ 
means a population that, as determined by the Sec-
retary, has a significant disparity in the overall rate
of disease incidence, prevalence, morbidity, mortality, 
or survival rates as compared to the health status of 
the general population. 
‘‘(3) The term ‘patient navigator’ means an in-
dividual who has completed a training program ap-
proved by the Secretary to perform the duties listed 
in subsection (b). 
‘‘(k) AUTHORIZATION OF APPROPRIATIONS.— 
‘‘(1) IN GENERAL.—To carry out this section, 
there are authorized to be appropriated $2,000,000 for 
fiscal year 2006, $5,000,000 for fiscal year 2007, 
$8,000,000 for fiscal year 2008, $6,500,000 for fiscal 
year 2009, and $3,500,000 for fiscal year 2010. 
‘‘(2) AVAILABILITY.—The amounts appropriated 
pursuant to paragraph (1) shall remain available for 
obligation through the end of fiscal year 2010.’’. 
Amend the title so as to read: ‘‘A bill to amend the 
Public Health Service Act to authorize a demonstration 
grant program to provide patient navigator services to re-
duce barriers and improve health care outcomes, and for 
other purposes.’’.
Union Calendar No. 447 
108TH CONGRESS 
2D SESSION 
H. R. 918 
[Report No. 108–727, Part I] 
A BILL 
To authorize the Health Resources and Services 
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 de-
tection, 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. 
OCTOBER 5, 2004 
Reported from the Committee on Energy and Commerce 
with amendments 
OCTOBER 5, 2004 
Referral to the Committee on Resources extended for a 
period ending not later than October 5, 2004 
OCTOBER 5, 2004 
Committee on Resources discharged; committed to the 
Committee of the Whole House on the State of the 
Union and ordered to be printed