‘‘(d) WAIVER OF SERVICES REQUIREMENT ON DIVI-
SION OF FUNDS.— 
‘‘(1) IN GENERAL.—The Secretary shall establish 
a demonstration project under which the Secretary 
may waive the requirements of paragraphs (1) and 
(4) of subsection (a) for not more than 5 States, if— 
‘‘(A) the State involved will use the waiver 
to leverage non-Federal funds to supplement each 
of the services or activities described in para-
graphs (1) and (2) of section 1501(a); 
‘‘(B) the application of such requirement 
would result in a barrier to the enrollment of 
qualifying women; 
‘‘(C) the State involved— 
‘‘(i) demonstrates, to the satisfaction of 
the Secretary, the manner in which the 
State will use such waiver to expand the 
level of screening and follow-up services pro-
vided immediately prior to the date on 
which the waiver is granted; and 
‘‘(ii) provides assurances, satisfactory 
to the Secretary, that the State will, on an 
annual basis, demonstrate, through such 
documentation as the Secretary may re-
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quire, that the State has used such waiver 
as described in clause (i); 
‘‘(D) the State involved submits to the Sec-
retary— 
‘‘(i) assurances, satisfactory to the Sec-
retary, that the State will maintain the av-
erage annual level of State fiscal year ex-
penditures for the services and activities de-
scribed in paragraphs (1) and (2) of section 
1501(a) for the period for which the waiver 
is granted, and for the period for which any 
extension of such wavier is granted, at a 
level that is not less than— 
‘‘(I) the level of the State fiscal 
year expenditures for such services and 
activities for the fiscal year preceding 
the first fiscal year for which the waiv-
er is granted; or 
‘‘(II) at the option of the State 
and upon approval by the Secretary, 
the average level of the State expendi-
tures for such services and activities 
for the 3-fiscal year period preceding 
the first fiscal year for which the waiv-
er is granted; and 
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‘‘(ii) a plan, satisfactory to the Sec-
retary, for maintaining the level of activi-
ties carried out under the waiver after the 
expiration of the waiver and any extension 
of such waiver; 
‘‘(E) the Secretary finds that granting such 
a waiver to a State will increase the number of 
women in the State that receive each of the serv-
ices or activities described in paragraphs (1) and 
(2) of section 1501(a), including making avail-
able screening procedures for both breast and cer-
vical cancers; and 
‘‘(F) the Secretary finds that granting such 
a waiver to a State will not adversely affect the 
quality of each of the services or activities de-
scribed in paragraphs (1) and (2) of section 
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 that is not less than 1 year but not 
more than 2 years; and 
‘‘(ii) upon request of a State, may ex-
tend a waiver for an additional period that 
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is not less than 1 year but not more than 
2 years in accordance with subparagraph 
(B). 
‘‘(B) ADDITIONAL PERIOD.—The Secretary, 
upon the request of a State that has received a 
waiver under paragraph (1), shall, at the end of 
the waiver period described in subparagraph 
(A)(i), review performance under the waiver and 
may extend the waiver for an additional period 
if the Secretary determines that— 
‘‘(i) without an extension of the waiv-
er, there will be a barrier to the enrollment 
of qualifying women; 
‘‘(ii) the State requesting such extended 
waiver will use the waiver to leverage non- 
Federal funds to supplement the services or 
activities described in paragraphs (1) and 
(2) of section 1501(a); 
‘‘(iii) the waiver has increased, and 
will continue to increase, the number of 
women in the State that receive the services 
or activities described in paragraphs (1) 
and (2) of section 1501(a); 
‘‘(iv) the waiver has not, and will not, 
result in lower quality in the State of the 
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services or activities described in para-
graphs (1) and (2) of section 1501(a); and 
‘‘(v) the State has maintained the av-
erage annual level of State fiscal expendi-
tures for the services and activities described 
in paragraphs (1) and (2) of section 
1501(a) for the period for which the waiver 
was granted at a level that is not less 
than— 
‘‘(I) the level of the State fiscal 
year expenditures for such services and 
activities for the fiscal year preceding 
the first fiscal year for which the waiv-
er is granted; or 
‘‘(II) at the option of the State 
and upon approval by the Secretary, 
the average level of the State expendi-
tures for such services and activities 
for the 3-fiscal year period preceding 
the first fiscal year for which the waiv-
er is granted. 
‘‘(3) REPORTING
REQUIREMENTS.—The Sec-
retary shall include as part of the evaluations and re-
ports required under section 1508, the following: 
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‘‘(A) A description of the total amount of 
dollars leveraged annually from Non-Federal en-
tities in States receiving a waiver under para-
graph (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 pro-
viding each of the services or activities described 
in— 
‘‘(i) paragraphs (1) and (2) of section 
1501(a); and 
‘‘(ii) paragraphs (3) through (6) of sec-
tion 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 
‘‘(ii) the average annual level of State 
fiscal expenditures for the services and ac-
tivities described in paragraphs (1) and (2) 
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