H. R. 2202
One Hundred Third Congress
of the
United States of America
AT THE FIRST SESSION
Begun and held at the City of Washington on Tuesday,
the fifth day of January, one thousand nine hundred and ninety-three
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.
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) SHORT TITLE.—This Act may be cited as the ‘‘Preventive
Health Amendments of 1993’’.
(b) TABLE OF CONTENTS.—The table of contents for this Act
is as follows:
Sec. 1. Short title; table of contents.
TITLE I—BREAST AND CERVICAL CANCER
Sec. 101. Revisions in program of State grants regarding breast and cervical can-
cer.
Sec. 102. Establishment of demonstration program of grants for additional preven-
tive health services for women.
Sec. 103. Funding for general program.
Sec. 104. Breast and cervical cancer information.
TITLE II—INJURY PREVENTION AND CONTROL
Sec. 201. Establishment of requirements with respect to interpersonal violence
within families and among acquaintances.
Sec. 202. Advisory committee; reports.
Sec. 203. Technical corrections.
Sec. 204. Authorization of appropriations.
TITLE III—TUBERCULOSIS
Sec. 301. Preventive health services regarding tuberculosis.
Sec. 302. Research through National Institute of Allergy and Infectious Diseases.
Sec. 303. Research through the Food and Drug Administration.
TITLE IV—SEXUALLY TRANSMITTED DISEASES
Sec. 401. Extension of program of grants regarding prevention and control of sexu-
ally transmitted diseases.
Sec. 402. Extension of program regarding preventable cases of infertility arising as
result of sexually transmitted diseases.
TITLE V—NATIONAL CENTER FOR HEALTH STATISTICS
Sec. 501. Revision and extension of programs.
TITLE VI—TRAUMA CARE SYSTEMS
Sec. 601. Revisions in programs relating to trauma care.
Sec. 602. Authorization of appropriations.
TITLE VII—MISCELLANEOUS PROVISIONS
Sec. 701. Evaluations.
Sec. 702. Federal benefits for overseas assignees.
Sec. 703. Loan repayment program.
19:19 Nov 23, 1993
VerDate 16-NOV-93
Jkt 059200
PO 00000
Frm 00001
Fmt 6655
Sfmt 6511
E:\BILLS\H2202.ENR
bend06
H. R. 2202—2
Sec. 704. Establishment of requirement of biennial report on nutrition and health.
Sec. 705. Alignment of current Centers for Disease Control and Prevention reau-
thorization schedule.
Sec. 706. Miscellaneous payment provisions.
Sec. 707. Interim final regulations.
Sec. 708. Simplification of vaccine information materials.
TITLE I—BREAST AND CERVICAL
CANCER
SEC. 101. REVISIONS IN PROGRAM OF STATE GRANTS REGARDING
BREAST AND CERVICAL CANCER.
(a) LIMITED AUTHORITY REGARDING FOR-PROFIT ENTITIES.—Sec-
tion 1501(b) of the Public Health Service Act (42 U.S.C. 300k(b)),
as amended by section 2008(c)(1) of Public Law 103–43 (107 Stat.
211), is amended—
(1) in paragraph (1), by striking ‘‘paragraph (2)’’ and insert-
ing ‘‘paragraphs (2) and (3)’’; and
(2) by striking paragraph (2) and inserting the following
paragraphs:
‘‘(2) LIMITED AUTHORITY REGARDING OTHER ENTITIES.—In
addition to the authority established in paragraph (1) for a
State with respect to grants and contracts, the State may
provide for screenings under subsection (a)(1) through entering
into contracts with private entities that are not nonprofit
entities.
‘‘(3) PAYMENTS FOR SCREENINGS.—The amount paid by a
State to an entity under this subsection for a screening proce-
dure under subsection (a)(1) may not exceed the amount that
would be paid under part B of title XVIII of the Social Security
Act if payment were made under such part for furnishing
the procedure to a woman enrolled under such part.’’.
(b) SPECIAL CONSIDERATION.—Section 1501 of the Public Health
Service Act (42 U.S.C. 300k) is amended by adding at the end
the following subsection:
‘‘(c) SPECIAL CONSIDERATION FOR CERTAIN STATES.—In making
grants under subsection (a) to States whose initial grants under
such subsection are made for fiscal year 1995 or any subsequent
fiscal year, the Secretary shall give special consideration to any
State whose proposal for carrying out programs under such
subsection—
‘‘(1) has been approved through a process of peer review;
and
‘‘(2) is made with respect to geographic areas in which
there is—
‘‘(A) a substantial rate of mortality from breast or
cervical cancer; or
‘‘(B) a substantial incidence of either of such cancers.’’.
(c) QUALITY ASSURANCE REGARDING SCREENING PROCEDURES.—
(1) IN GENERAL.—Section 1503 of the Public Health Service
Act (42 U.S.C. 300m) is amended by striking subsections (c)
through (e) and inserting the following:
‘‘(c) QUALITY
ASSURANCE
REGARDING
SCREENING
PROCE-
DURES.—The Secretary may not make a grant under section 1501
unless the State involved agrees that the State will, in accordance
with applicable law, assure the quality of screening procedures
conducted pursuant to such section.’’.
19:19 Nov 23, 1993
VerDate 16-NOV-93
Jkt 059200
PO 00000
Frm 00002
Fmt 6655
Sfmt 6501
E:\BILLS\H2202.ENR
bend06
H. R. 2202—3
(2) TRANSITION RULE REGARDING MAMMOGRAPHIES.—With
respect to the screening procedure for breast cancer known
as a mammography, the requirements in effect on the day
before the date of the enactment of this Act under section
1503(c) of the Public Health Service Act remain in effect (for
an individual or facility conducting such procedures pursuant
to a grant to a State under section 1501 of such Act) until
there is in effect for the facility a certificate (or provisional
certificate) issued under section 354 of such Act.
(d) STATEWIDE PROVISION OF SERVICES.—Section 1504(c) of the
Public Health Service Act (42 U.S.C. 300n(c)) is amended by adding
at the end the following paragraph:
‘‘(3) GRANTS TO TRIBES AND TRIBAL ORGANIZATIONS.—
‘‘(A) The Secretary, acting through the Director of the
Centers for Disease Control and Prevention, may make
grants to tribes and tribal organizations (as such terms
are used in paragraph (1)) for the purpose of carrying
out programs described in section 1501(a). This title applies
to such a grant (in relation to the jurisdiction of the tribe
or organization) to the same extent and in the same manner
as such title applies to a grant to a State under section
1501 (in relation to the jurisdiction of the State).
‘‘(B) If a tribe or tribal organization is receiving a
grant under subparagraph (A) and the State in which
the tribe or organization is located is receiving a grant
under section 1501, the requirement established in para-
graph (1) for the State regarding the tribe or organization
is deemed to have been waived under paragraph (2).’’.
(e) EVALUATIONS AND REPORTS.—Section 1508 of the Public
Health Service Act (42 U.S.C. 300n–4) is amended—
(1) in subsection (a), by adding at the end the following
sentence: ‘‘Such evaluations shall include evaluations of the
extent to which States carrying out such programs are in
compliance with section 1501(a)(2) and with section 1504(c).’’;
and
(2) in subsection (b), by inserting before the period the
following: ‘‘, including recommendations regarding compliance
by the States with section 1501(a)(2) and with section 1504(c)’’.
(f) ESTABLISHMENT
OF
COORDINATING
COMMITTEE.—Section
1501 of the Public Health Service Act (42 U.S.C. 300k) is amended
by adding at the end the following subsection:
‘‘(c) COORDINATING COMMITTEE REGARDING YEAR 2000 HEALTH
OBJECTIVES.—The Secretary, acting through the Director of the
Centers for Disease Control and Prevention, shall establish a
committee to coordinate the activities of the agencies of the Public
Health Service (and other appropriate Federal agencies) that are
carried out toward achieving the objectives established by the Sec-
retary for reductions in the rate of mortality from breast and
cervical cancer in the United States by the year 2000. Such commit-
tee shall be comprised of Federal officers or employees designated
by the heads of the agencies involved to serve on the committee
as representatives of the agencies, and such representatives from
other public or private entities as the Secretary determines to
be appropriate.’’.
(g) TECHNICAL CORRECTIONS.—Title XV of the Public Health
Service Act (42 U.S.C. 300k et seq.) is amended—
19:19 Nov 23, 1993
VerDate 16-NOV-93
Jkt 059200
PO 00000
Frm 00003
Fmt 6655
Sfmt 6501
E:\BILLS\H2202.ENR
bend06
H. R. 2202—4
(1) in section 1501(a), in the matter preceding paragraph
(1), by striking ‘‘Control,’’ and inserting ‘‘Control and Preven-
tion,’’; and
(2) in section 1505—
(A) in paragraph (3) (as amended by section 2008(c)(2)
of Public Law 103–43 (107 Stat. 211)), by striking ‘‘public’’
and all that follows and inserting ‘‘public and nonprofit
private entities; and’’; and
(B) in paragraph (4), by inserting ‘‘will’’ before ‘‘be
used’’.
SEC. 102. ESTABLISHMENT 
OF 
DEMONSTRATION 
PROGRAM 
OF
GRANTS FOR ADDITIONAL PREVENTIVE HEALTH SERV-
ICES FOR WOMEN.
(a) IN GENERAL.—Title XV of the Public Health Service Act
(42 U.S.C. 300k et seq.) is amended—
(1) by redesignating section 1509 as section 1510; and
(2) by inserting after section 1508 the following section:
‘‘SEC. 1509. SUPPLEMENTAL GRANTS FOR ADDITIONAL PREVENTIVE
HEALTH SERVICES.
‘‘(a) DEMONSTRATION PROJECTS.—In the case of States receiving
grants under section 1501, the Secretary, acting through the Direc-
tor of the Centers for Disease Control and Prevention, may make
grants to not more than 3 such States to carry out demonstration
projects for the purpose of—
‘‘(1) providing preventive health services in addition to
the services authorized in such section, including screenings
regarding blood pressure and cholesterol, and including health
education;
‘‘(2) providing appropriate referrals for medical treatment
of women receiving services pursuant to paragraph (1) and
ensuring, to the extent practicable, the provision of appropriate
follow-up services; and
‘‘(3) evaluating activities conducted under paragraphs (1)
and (2) through appropriate surveillance or program-monitoring
activities.
‘‘(b) STATUS AS PARTICIPANT IN PROGRAM REGARDING BREAST
AND CERVICAL CANCER.—The Secretary may not make a grant
under subsection (a) unless the State involved agrees that services
under the grant will be provided only through entities that are
screening women for breast or cervical cancer pursuant to a grant
under section 1501.
‘‘(c) APPLICABILITY OF PROVISIONS OF GENERAL PROGRAM.—This
title applies to a grant under subsection (a) to the same extent
and in the same manner as such title applies to a grant under
section 1501.
‘‘(d) FUNDING.—
‘‘(1) IN GENERAL.—Subject to paragraph (2), for the purpose
of carrying out this section, there are authorized to be appro-
priated $3,000,000 for fiscal year 1994, and such sums as
may be necessary for each of the fiscal years 1995 through
1998.
‘‘(2) LIMITATION
REGARDING
FUNDING
WITH
RESPECT
TO
BREAST AND CERVICAL CANCER.—The authorization of appropria-
tions established in paragraph (1) is not effective for a fiscal
year unless the amount appropriated under section 1510(a)
for the fiscal year is equal to or greater than $100,000,000.’’.
19:19 Nov 23, 1993
VerDate 16-NOV-93
Jkt 059200
PO 00000
Frm 00004
Fmt 6655
Sfmt 6501
E:\BILLS\H2202.ENR
bend06
H. R. 2202—5
(b) CONFORMING AMENDMENT.—Section 1510(a) of the Public
Health Service Act, as redesignated by subsection (a)(1) of this
section, is amended in the heading for the section by striking
‘‘FUNDING.’’ and inserting ‘‘FUNDING FOR GENERAL PROGRAM.’’.
SEC. 103. FUNDING FOR GENERAL PROGRAM.
Section 1510(a) of the Public Health Service Act, as redesig-
nated by section 102(a)(1) of this Act, is amended—
(1) by striking ‘‘and’’ after ‘‘1991,’’; and
(2) by inserting before the period the following: ‘‘,
$150,000,000 for fiscal year 1994, and such sums as may be
necessary for each of the fiscal years 1995 through 1998’’.
SEC. 104. BREAST AND CERVICAL CANCER INFORMATION.
Part D of title III of the Public Health Service Act (42 U.S.C.
254b et seq.), as amended by section 2008(i)(2)(A) of Public Law
103–43 (107 Stat. 213), is amended by adding at the end the
following new section:
‘‘BREAST AND CERVICAL CANCER INFORMATION
‘‘SEC. 340D. (a) IN GENERAL.—As a condition of receiving
grants, cooperative agreements, or contracts under this Act, each
of the entities specified in subsection (c) shall, to the extent deter-
mined to be appropriate by the Secretary, make available informa-
tion concerning breast and cervical cancer.
‘‘(b) CERTAIN AUTHORITIES.—In carrying out subsection (a), an
entity specified in subsection (c)—
‘‘(1) may make the information involved available to such
individuals as the entity determines appropriate;
‘‘(2) may, as appropriate, provide information under sub-
section (a) on the need for self-examination of the breasts
and on the skills for such self-examinations;
‘‘(3) shall provide information under subsection (a) in the
language and cultural context most appropriate to the individ-
uals to whom the information is provided; and
‘‘(4) shall refer such clients as the entities determine appro-
priate for breast and cervical cancer screening, treatment, or
other appropriate services.
‘‘(c) RELEVANT ENTITIES.—The entities specified in this sub-
section are the following:
‘‘(1) Entities receiving assistance under section 317E (relat-
ing to tuberculosis).
‘‘(2) Entities receiving assistance under section 318 (relat-
ing to sexually transmitted diseases).
‘‘(3) Migrant health centers receiving assistance under sec-
tion 329.
‘‘(4) Community health centers receiving assistance under
section 330.
‘‘(5) Entities receiving assistance under section 340 (relat-
ing to homeless individuals).
‘‘(6) Entities receiving assistance under section 340A (relat-
ing to health services for residents of public housing).
‘‘(7) Entities providing services with assistance under title
V or title XIX.
‘‘(8) Entities receiving assistance under section 1001 (relat-
ing to family planning).
19:19 Nov 23, 1993
VerDate 16-NOV-93
Jkt 059200
PO 00000
Frm 00005
Fmt 6655
Sfmt 6501
E:\BILLS\H2202.ENR
bend06
H. R. 2202—6
‘‘(9) Entities receiving assistance under title XXVI (relating
to services with respect to acquired immune deficiency syn-
drome).
‘‘(10) Non-Federal entities authorized under the Indian
Self-Determination Act.’’.
TITLE II—INJURY PREVENTION AND
CONTROL
SEC. 201. ESTABLISHMENT OF REQUIREMENTS WITH RESPECT TO
INTERPERSONAL 
VIOLENCE 
WITHIN 
FAMILIES 
AND
AMONG ACQUAINTANCES.
Part J of title III of the Public Health Service Act (42 U.S.C.
280b et seq.), as redesignated by section 2008(i)(2)(B)(i) of Public
Law 103–43 (107 Stat. 213), is amended—
(1) by redesignating sections 393 and 394 as sections 394
and 394A, respectively; and
(2) by inserting after section 392 the following section:
‘‘INTERPERSONAL VIOLENCE WITHIN FAMILIES AND AMONG
ACQUAINTANCES
‘‘SEC. 393. (a) With respect to activities that are authorized
in sections 391 and 392, the Secretary, acting through the Director
of the Centers for Disease Control and Prevention, shall carry
out such activities with respect to interpersonal violence within
families and among acquaintances. Activities authorized in the
preceding sentence include the following:
‘‘(1) Collecting data relating to the incidence of such
violence.
‘‘(2) Making grants to public and nonprofit private entities
for the evaluation of programs whose purpose is to prevent
such violence, including the evaluation of demonstration
projects under paragraph (6).
‘‘(3) Making grants to public and nonprofit private entities
for the conduct of research on identifying effective strategies
for preventing such violence.
‘‘(4) Providing to the public information and education on
such violence, including information and education to increase
awareness of the public health consequences of such violence.
‘‘(5) Training health care providers as follows:
‘‘(A) To identify individuals whose medical conditions
or statements indicate that the individuals are victims
of such violence.
‘‘(B) To routinely determine, in examining patients,
whether the medical conditions or statements of the
patients so indicate.
‘‘(C) To refer individuals so identified to entities that
provide services regarding such violence, including referrals
for counseling, housing, legal services, and services of
community organizations.
‘‘(6) Making grants to public and nonprofit private entities
for demonstration projects with respect to such violence, includ-
ing with respect to prevention.
‘‘(b) For purposes of this part, the term ‘interpersonal violence
within families and among acquaintances’ includes behavior com-
19:19 Nov 23, 1993
VerDate 16-NOV-93
Jkt 059200
PO 00000
Frm 00006
Fmt 6655
Sfmt 6501
E:\BILLS\H2202.ENR
bend06
H. R. 2202—7
monly referred to as domestic violence, sexual assault, spousal
abuse, woman battering, partner abuse, elder abuse, and acquaint-
ance rape.’’.
SEC. 202. ADVISORY COMMITTEE; REPORTS.
Section 394 of the Public Health Service Act, as redesignated
by section 201(1) of this Act, is amended to read as follows:
‘‘GENERAL PROVISIONS
‘‘SEC. 394. (a) The Secretary, acting through the Director of
the Centers for Disease Control and Prevention, shall establish
an advisory committee to advise the Secretary and such Director
with respect to the prevention and control of injuries.
‘‘(b) The Secretary, acting through the Director of the Centers
for Disease Control and Prevention, may provide technical assist-
ance to public and nonprofit private entities with respect to the
planning, development, and operation of any program or service
carried out pursuant to this part. The Secretary may provide such
technical assistance directly or through grants or contracts.
‘‘(c) Not later than February 1 of 1995 and of every second
year thereafter, the Secretary, acting through the Director of the
Centers for Disease Control and Prevention, shall submit to the
Committee on Energy and Commerce of the House of Representa-
tives, and to the Committee on Labor and Human Resources of
the Senate, a report describing the activities carried out under
this part during the preceding 2 fiscal years. Such report shall
include a description of such activities that were carried out with
respect to interpersonal violence within families and among
acquaintances and with respect to rural areas.’’.
SEC. 203. TECHNICAL CORRECTIONS.
(a) TERMINOLOGY.—Part J of title III of the Public Health
Service Act (42 U.S.C. 280b et seq.), as redesignated by section
2008(i)(2)(B)(i) of Public Law 103–43 (107 Stat. 213), is amended—
(1) in the heading for such part, by striking ‘‘INJURY CON-
TROL’’ and inserting ‘‘PREVENTION AND CONTROL OF INJURIES’’;
and
(2) in section 392—
(A) in the heading for such section, by inserting
‘‘PREVENTION AND’’ before ‘‘CONTROL ACTIVITIES’’;
(B) in subsection (a)(1), by inserting ‘‘and control’’ after
‘‘prevention’’; and
(C) in subsection (b)(1), by striking ‘‘injuries and injury
control’’ and inserting ‘‘the prevention and control of
injuries’’.
(b) PROVISIONS RELATING TO PUBLIC LAW 102–531.—Part J
of title III of the Public Health Service Act (42 U.S.C. 280b et
seq.), as amended by section 301 of Public Law 102–531 (106
Stat. 3482) and as redesignated by section 2008(i)(2)(B)(i) of Public
Law 103–43 (107 Stat. 213), is amended—
(1) in section 392(b)(2), by striking ‘‘to promote injury con-
trol’’ and all that follows and inserting ‘‘to promote activities
regarding the prevention and control of injuries; and’’; and
(2) in section 391(b), by adding at the end the following
sentence: ‘‘In carrying out the preceding sentence, the Secretary
shall disseminate such information to the public, including
through elementary and secondary schools.’’.
19:19 Nov 23, 1993
VerDate 16-NOV-93
Jkt 059200
PO 00000
Frm 00007
Fmt 6655
Sfmt 6501
E:\BILLS\H2202.ENR
bend06