I 
108TH CONGRESS 
2D SESSION 
H. R. 4093 
To amend the Public Health Service Act to establish a program of grants 
for the detection and control of colorectal cancer. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 31, 2004 
Mr. KENNEDY of Rhode Island introduced the following bill; which was 
referred to the Committee on Energy and Commerce 
A BILL 
To amend the Public Health Service Act to establish a pro-
gram of grants for the detection and control of colorectal 
cancer. 
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 ‘‘Colorectal Cancer Mor-
tality Prevention Act of 2004’’.
SEC. 2. ESTABLISHMENT OF PROGRAM OF GRANTS TO 
STATES FOR DETECTION AND CONTROL OF 
COLORECTAL CANCER. 
The Public Health Service Act (42 U.S.C. 201 et 
seq.) is amended by inserting after title XXVIII the fol-
lowing new title: 
‘‘TITLE 
XXIX—PREVENTIVE 
HEALTH MEASURES WITH RE-
SPECT TO COLORECTAL CAN-
CERS 
‘‘SEC. 2901. ESTABLISHMENT OF PROGRAM OF GRANTS TO 
STATES. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Director of the Centers for Disease Control and Pre-
vention, may make grants to States on the basis of an 
established competitive review process for the purpose of 
carrying out programs— 
‘‘(1) to screen for colorectal cancer as a preven-
tive health measure; 
‘‘(2) to provide appropriate referrals for medical 
treatment of individuals screened pursuant to para-
graph (1) and to ensure, to the extent practicable, 
the provision of appropriate follow-up services; 
‘‘(3) to develop and disseminate public informa-
tion and education programs for the detection and 
control of colorectal cancer;
‘‘(4) to improve the education, training, and 
skills of health professionals (including allied health 
professionals) in the detection and control of 
colorectal cancer; 
‘‘(5) to establish mechanisms through which the 
States can monitor the quality of screening proce-
dures for colorectal cancer, including the interpreta-
tion of such procedures; and 
‘‘(6) to evaluate activities conducted under 
paragraphs (1) through (5) through appropriate sur-
veillance or program-monitoring activities. 
‘‘(b) GRANT
AND
CONTRACT
AUTHORITY
OF 
STATES.—A State receiving a grant under subsection (a) 
may expend the grant to carry out the purpose described 
in such subsection through grants to, and contracts with, 
public or nonprofit private entities. 
‘‘SEC. 2902. REQUIREMENT OF MATCHING FUNDS. 
‘‘(a) IN GENERAL.—The Secretary may not make a 
grant under section 2901 unless the State involved agrees, 
with respect to the costs to be incurred by the State in 
carrying out the purpose described in such section, to 
make available non-Federal contributions (in cash or in 
kind under subsection (b)) toward such costs in an amount 
that is not less than $1 for each $3 of Federal funds pro-
vided in the grant. Such contributions may be made di-
rectly or through donations from public or private entities. 
‘‘(b) DETERMINATION OF AMOUNT OF NON-FED-
ERAL CONTRIBUTION.— 
‘‘(1) IN GENERAL.—Non-Federal contributions 
required in subsection (a) may be in cash or in kind, 
fairly evaluated, including equipment or services 
(and excluding indirect or overhead costs). Amounts 
provided by the Federal Government, or services as-
sisted or subsidized to any significant extent by the 
Federal Government, may not be included in deter-
mining the amount of such non-Federal contribu-
tions. 
‘‘(2) MAINTENANCE OF EFFORT.—In making a 
determination of the amount of non-Federal con-
tributions for purposes of subsection (a), the Sec-
retary may include only non-Federal contributions in 
excess of the average amount of non-Federal con-
tributions made by the State involved toward the 
purpose described in section 2901 for the 2-year pe-
riod preceding the first fiscal year for which the 
State is applying to receive a grant under such sec-
tion. 
‘‘(3) INCLUSION OF RELEVANT NON-FEDERAL 
CONTRIBUTIONS FOR MEDICAID.—In making a de-
termination of the amount of non-Federal contribu-
tions for purposes of subsection (a), the Secretary 
shall, subject to paragraphs (1) and (2) of this sub-
section, include any non-Federal amounts expended 
pursuant to title XIX of the Social Security Act by 
the State involved toward the purpose described in 
paragraphs (1) and (2) of section 2901(a). 
‘‘SEC. 2903. REQUIREMENTS WITH RESPECT TO TYPE AND 
QUALITY OF SERVICES. 
‘‘(a) REQUIREMENT OF PROVISION OF ALL SERVICES 
BY DATE CERTAIN.—The Secretary may not make a 
grant under section 2901 unless the State involved 
agrees— 
‘‘(1) to ensure that, initially and throughout the 
period during which amounts are received pursuant 
to the grant, not less than 60 percent of the grant 
is expended to provide each of the services or activi-
ties described in paragraphs (1) and (2) of section 
2901(a), including making available screening proce-
dures for colorectal cancer; 
‘‘(2) to ensure that, by the end of any second 
fiscal year of payments pursuant to the grant, each 
of the services or activities described in section 
2901(a) is provided; and
‘‘(3) to ensure that not more than 40 percent 
of the grant is expended to provide the services or 
activities described in paragraphs (3) through (6) of 
such section. 
‘‘(b) QUALITY ASSURANCE REGARDING SCREENING 
FOR COLORECTAL CANCER.—The Secretary may not 
make a grant under section 2901 unless the State in-
volved— 
‘‘(1) assures the quality of any screening proce-
dure for colorectal cancer conducted pursuant to 
such section; and 
‘‘(2) assures that, with respect to the first 
colorectal cancer screening performed on an indi-
vidual for which payment is made pursuant to sec-
tion 2901(a), there are satisfactory assurances that 
the results of the screening will be placed in perma-
nent medical records maintained with respect to the 
individual. 
‘‘(c) ISSUANCE
BY SECRETARY
OF GUIDELINES 
WITH RESPECT
TO QUALITY
OF COLORECTAL SERV-
ICES.— 
‘‘(1) IN GENERAL.—The Secretary shall issue 
guidelines for assuring the quality of any colorectal 
screening procedure conducted pursuant to section 
2901(a).
‘‘(2) 
APPLICABILITY
WITH
RESPECT
TO 
GRANTS.—The Secretary may not make a grant 
under section 2901 unless the State involved agrees 
that the State will, with respect to any colorectal 
screening procedure conducted pursuant to such sec-
tion, ensure that the procedure is conducted in ac-
cordance with the guidelines issued by the Secretary 
under paragraph (1). 
‘‘SEC. 2904. ADDITIONAL REQUIRED AGREEMENTS. 
‘‘(a) PRIORITY FOR LOW-INCOME INDIVIDUALS.— 
The Secretary may not make a grant under section 2901 
unless the State involved agrees that low-income individ-
uals will be given priority in the provision of services and 
activities pursuant to paragraphs (1) and (2) of section 
2901(a). 
‘‘(b) LIMITATION
ON IMPOSITION
OF FEES
FOR 
SERVICES.—The Secretary may not make a grant under 
section 2901 unless the State involved agrees that, if a 
charge is imposed for the provision of services or activities 
under the grant, such charge— 
‘‘(1) will be made according to a schedule of 
charges that is made available to the public; 
‘‘(2) will be adjusted to reflect the income of 
the individuals involved; and
‘‘(3) will not be imposed on any individual with 
an income of less than 100 percent of the official 
poverty line, as established by the Director of the 
Office of Management and Budget and revised by 
the Secretary in accordance with section 673(2) of 
the Omnibus Budget Reconciliation Act of 1981. 
‘‘(c) STATEWIDE PROVISION OF SERVICES.— 
‘‘(1) IN
GENERAL.—The Secretary may not 
make a grant under section 2901 unless the State 
involved agrees that services and activities under the 
grant will be made available throughout the State, 
including availability to members of any Indian tribe 
or tribal organization (as such terms are defined in 
section 4 of the Indian Self-Determination and Edu-
cation Assistance Act). 
‘‘(2) WAIVER.—The Secretary may waive the 
requirement established in paragraph (1) for a State 
if the Secretary determines that compliance by the 
State with the requirement would result in an ineffi-
cient allocation of resources with respect to carrying 
out the purpose described in section 2901(a). 
‘‘(d) RELATIONSHIP
TO
ITEMS
AND
SERVICES 
UNDER OTHER PROGRAMS.—The Secretary may not 
make a grant under section 2901 unless the State involved 
agrees that the grant will not be expended to make pay-
ment for any item or service to the extent that payment 
has been made, or can reasonably be expected to be made, 
with respect to such item or service— 
‘‘(1) under any State compensation program, 
under an insurance policy, or under any Federal or 
State health benefits program; or 
‘‘(2) by an entity that provides health services 
on a prepaid basis. 
‘‘(e) COORDINATION
WITH
OTHER
COLORECTAL 
CANCER PROGRAMS.—The Secretary may not make a 
grant under section 2901 unless the State involved agrees 
that the services and activities funded through the grant 
will be coordinated with other Federal, State, and local 
colorectal cancer programs. 
‘‘(f) LIMITATION ON ADMINISTRATIVE EXPENSES.— 
The Secretary may not make a grant under section 2901 
unless the State involved agrees that not more than 10 
percent of the grant will be expended for administrative 
expenses with respect to the grant. 
‘‘(g) RESTRICTIONS ON USE OF GRANT.—The Sec-
retary may not make a grant under section 2901 unless 
the State involved agrees that the grant will not be ex-
pended to provide inpatient hospital services (as that term 
is defined by the Secretary for purposes of this sub-
section).
‘‘(h) RECORDS AND AUDITS.—The Secretary may not 
make a grant under section 2901 unless the State involved 
agrees that— 
‘‘(1) the State will establish such fiscal control 
and fund accounting procedures as may be necessary 
to ensure the proper disbursement of, and account-
ing for, amounts received by the State under such 
section; and 
‘‘(2) upon request, the State will provide 
records maintained pursuant to paragraph (1) to the 
Secretary or the Comptroller General of the United 
States for purposes of auditing the expenditures by 
the State of the grant. 
‘‘(i) REPORTS TO SECRETARY.—The Secretary may 
not make a grant under section 2901 unless the State in-
volved agrees to submit to the Secretary such reports as 
the Secretary may require with respect to the grant. 
‘‘SEC. 2905. DESCRIPTION OF INTENDED USES OF GRANT. 
‘‘The Secretary may not make a grant under section 
2901 unless— 
‘‘(1) the State involved submits to the Secretary 
a description of the purposes for which the State in-
tends to expend the grant;
‘‘(2) the description identifies the populations, 
areas, and localities in the State with a need for the 
services or activities described in section 2901(a); 
‘‘(3) the description provides information relat-
ing to the services and activities to be provided, in-
cluding a description of the manner in which the 
services and activities will be coordinated with any 
similar services or activities of public or nonprofit 
entities; and 
‘‘(4) the description provides assurances that 
the grant funds be used in the most cost-effective 
manner. 
‘‘SEC. 2906. REQUIREMENT OF SUBMISSION OF APPLICA-
TION. 
‘‘The Secretary may not make a grant under section 
2901 unless an application for the grant is submitted to 
the Secretary, the application contains the description of 
intended uses required in section 2905, and the applica-
tion is in such form, is made in such manner, and contains 
such agreements, assurances, and information as the Sec-
retary determines to be necessary to carry out this title.