II 
109TH CONGRESS 
2D SESSION 
H. R. 5472 
IN THE SENATE OF THE UNITED STATES 
DECEMBER 9 (legislative day, DECEMBER 8), 2006 
Received 
AN ACT 
To amend the Public Health Service Act to provide waivers 
relating to grants for preventive health measures with 
respect to breast and cervical cancers. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘National Breast and 
Cervical Cancer Early Detection Program Reauthorization 
Act of 2006’’. 
SEC. 2. NATIONAL BREAST AND CERVICAL CANCER EARLY 
DETECTION PROGRAM. 
Title XV of the Public Health Service Act (42 U.S.C. 
300k et seq.) is amended— 
(1) in section 1501(d)— 
(A) in the heading, by striking ‘‘2000’’ and 
inserting ‘‘2020’’; and 
(B) by striking ‘‘by the year 2000’’ and in-
serting ‘‘by the year 2020’’; 
(2) in section 1503, by adding at the end the 
following: 
‘‘(d) WAIVER OF SERVICES REQUIREMENT ON DIVI-
SION OF FUNDS.— 
‘‘(1) IN GENERAL.—The Secretary shall estab-
lish a demonstration project under which the Sec-
retary, acting through the Director of the Centers 
for Disease Control and Prevention, may waive the 
requirements of paragraphs (1) and (4) of sub-
section (a) for not more than 5 States, if— 
‘‘(A)(i) the State involved will use the 
waiver to leverage private funds to supplement 
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each of the services or activities described in 
paragraphs (1) and (2) of section 1501(a); or 
‘‘(ii) the application of such requirement 
would result in a barrier to the enrollment of 
qualifying women; 
‘‘(B) the State involved provides assur-
ances that the State will, on an annual basis, 
demonstrate to the Secretary the manner in 
which the State will use such waiver to main-
tain or expand the level of screening and follow- 
up services provided immediately prior to the 
waiver, and provide documentation of compli-
ance with such maintenance or expansion re-
quirement; 
‘‘(C) the State involved submits to the Sec-
retary a plan for maintaining the level of activi-
ties carried out under the waiver after the expi-
ration of the waiver; 
‘‘(D) the Secretary finds that granting 
such a waiver to a State will not reduce the 
number of women in the State that receive each 
of the services or activities described in para-
graphs (1) and (2) of section 1501(a), including 
making available screening procedures for both 
breast and cervical cancers; and 
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‘‘(E) the Secretary finds that granting 
such a waiver to a State will not adversely af-
fect the quality of each of the services or activi-
ties described in paragraphs (1) and (2) of sec-
tion 1501(a). 
‘‘(2) DURATION OF WAIVER.— 
‘‘(A) IN
GENERAL.—In granting waivers 
under paragraph (1), the Secretary— 
‘‘(i) shall grant such waivers for a pe-
riod of 2 years; and 
‘‘(ii) upon request of a State, may ex-
tend a waiver for an additional 2-year pe-
riod in accordance with subparagraph (B). 
‘‘(B) 
ADDITIONAL
PERIOD.—The 
Sec-
retary, upon the request of a State that has re-
ceived a waiver under paragraph (1), shall, at 
the end of the 2-year waiver period described in 
subparagraph (A), review performance under 
the waiver and may extend the waiver for an 
additional 2-year period if the Secretary deter-
mines that— 
‘‘(i)(I) without an extension of the 
waiver, there will be a barrier to the enroll-
ment of qualifying women; or 
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‘‘(II) the State requesting such ex-
tended waiver will use the waiver to lever-
age private funds to supplement the serv-
ices or activities described in paragraphs 
(1) and (2) of section 1501(a); 
‘‘(ii) the waiver has not, and will not, 
reduce the number of women in the State 
that receive the services or activities de-
scribed in paragraphs (1) and (2) of sec-
tion 1501(a); 
‘‘(iii) the waiver has not, and will not, 
result in lower quality in the State of the 
services or activities described in para-
graphs (1) and (2) of section 1501(a); and 
‘‘(iv) the State has maintained the av-
erage annual level of State fiscal expendi-
tures for the services and activities de-
scribed in paragraphs (1) and (2) of sec-
tion 1501(a) for the 2 years for which the 
waiver was granted at a level that is not 
less than the level of the State fiscal ex-
penditures for such services and activities 
for the year preceding the first year for 
which the waiver is granted. 
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‘‘(3) REPORTING
REQUIREMENTS.—The Sec-
retary shall include as part of the evaluations and 
reports required under section 1508, the following: 
‘‘(A) A description of the total amount of 
dollars leveraged annually from private entities 
in States receiving a waiver under paragraph 
(1) and how these amounts were used. 
‘‘(B) With respect to States receiving a 
waiver under paragraph (1), a description of 
the percentage of the grant that is expended on 
providing each of the services or activities de-
scribed in— 
‘‘(i) paragraphs (1) and (2) of section 
1501(a); and 
‘‘(ii) paragraphs (3) through (6) of 
section 1501(a). 
‘‘(C) A description of the number of States 
receiving waivers under paragraph (1) annually. 
‘‘(D) With respect to States receiving a 
waiver under paragraph (1), a description of— 
‘‘(i) the number of women receiving 
services under paragraphs (1), (2), and (3) 
of section 1501(a) in programs before and 
after the granting of such waiver; and 
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‘‘(ii) the average annual level of State 
fiscal expenditures for the services and ac-
tivities described in paragraphs (1) and (2) 
of section 1501(a) for the year preceding 
the first year for which the waiver was 
granted. 
‘‘(4) LIMITATION.—Amounts to which a waiver 
applies under this subsection shall not be used to in-
crease the number of salaried employees. 
‘‘(5) DEFINITIONS.—In this subsection: 
‘‘(A) INDIAN
TRIBE.—The term ‘Indian 
tribe’ has the meaning given the term in section 
4 of the Indian Health Care Improvement Act 
(25 U.S.C. 1603). 
‘‘(B) TRIBAL
ORGANIZATION.—The term 
‘tribal organization’ has the meaning given the 
term in section 4 of the Indian Health Care Im-
provement Act. 
‘‘(C) STATE.—The term ‘State’ means 
each of the several States of the United States, 
the District of Columbia, the Commonwealth of 
Puerto Rico, American Samoa, the Common-
wealth of the Northern Mariana Islands, the 
Republic of the Marshall Islands, the Federated 
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States of Micronesia, the Republic of Palau, an 
Indian tribe, and a tribal organization.’’; 
(3) in section 1508— 
(A) in subsection (a), by striking ‘‘evalua-
tions of the extent to which’’ and all that fol-
lows through the period and inserting: ‘‘evalua-
tions of— 
‘‘(1) the extent to which States carrying out 
such programs are in compliance with section 
1501(a)(2) and with section 1504(c); and 
‘‘(2) the extent to which each State receiving a 
grant under this title is in compliance with section 
1502, including identification of— 
‘‘(A) the amount of the non-Federal con-
tributions by the State for the preceding fiscal 
year, disaggregated according to the source of 
the contributions; and 
‘‘(B) the proportion of such amount of 
non-Federal 
contributions 
relative 
to 
the 
amount of Federal funds provided through the 
grant to the State for the preceding fiscal 
year.’’; and 
(B) in subsection (b), by striking ‘‘not 
later than 1 year after the date on which 
amounts are first appropriated pursuant to sec-
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tion 1509(a), and annually thereafter’’ and in-
serting ‘‘not later than 1 year after the date of 
the enactment of the National Breast and Cer-
vical Cancer Early Detection Program Reau-
thorization of 2006, and annually thereafter’’; 
and 
(4) in section 1510(a)— 
(A) by striking ‘‘and’’ after ‘‘$150,000,000 
for fiscal year 1994,’’; and 
(B) by inserting ‘‘, $225,000,000 for fiscal 
year 2007, $245,000,000 for fiscal year 2008, 
$250,000,000 
for 
fiscal 
year 
2009, 
$255,000,000 
for 
fiscal 
year 
2010, 
and 
$275,000,000 for fiscal year 2011’’ before the 
period at the end. 
Passed the House of Representatives December 9 
(legislative day, December 8), 2006. 
Attest: 
KAREN L. HAAS, 
Clerk. 
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