I
107TH CONGRESS
2D SESSION
H. R. 5187
To authorize the Health Resources and Services Administration and the
National Cancer Institute 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
JULY 23, 2002
Mr. MENENDEZ (for himself, Ms. ROS-LEHTINEN, Mr. GREEN of Texas, Mrs.
CHRISTENSEN, Mr. THOMPSON of Mississippi, Mr. DIAZ-BALART, Mr.
SERRANO, Mr. SMITH of New Jersey, Ms. LEE, Mrs. JONES of Ohio, Mr.
FROST, Mr. CONYERS, Ms. WOOLSEY, Mr. RODRIGUEZ, Ms. ROYBAL-AL-
LARD, Mr. BACA, Mr. GONZALEZ, Mr. HINOJOSA, Mr. CUMMINGS, Mr.
ACEVEDO-VILA´, Mr. PALLONE, Mr. PASTOR, Mr. UDALL of New Mexico,
Mr. PASCRELL, Mr. STARK, Mr. PAYNE, Mr. BENTSEN, and Mr. ROTH-
MAN) introduced the following bill; which was referred to the Committee
on Energy and Commerce
A BILL
To authorize the Health Resources and Services Administra-
tion and the National Cancer Institute to make grants
for model programs to provide to individuals of health
disparity populations prevention, early detection, treat-
ment, and appropriate follow-up care services for cancer
and chronic diseases, and to make grants regarding pa-
tient 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,
Outreach, and Chronic Disease Prevention Act of 2002’’.
SEC. 2. FINDINGS.
The Congress finds as follows:
(1) Despite notable progress in the overall
health of the Nation, there are continuing disparities
in the burden of illness and death experienced by Af-
rican Americans, Latinos and Hispanics, Native
Americans, Alaska Natives, Asian and Pacific Is-
landers and the poor, compared to the United States
population as a whole.
(2) Many racial and ethnic minority groups suf-
fer disproportionately from cancer. Mortality and
morbidity rates remain the most important measures
of the overall progress against cancer. Decreasing
rates of death from cancer reflect improvements in
both prevention and treatment. Among all ethnic
groups in the United States, African American
males have the highest overall rate of mortality from
cancer. Some specific forms of cancer affect other
ethnic minority communities at rates up to several
times higher than the national averages (such as
stomach and liver cancers among Asian American
populations, colon and rectal cancer among Alaska
natives, and cervical cancer among Hispanic and Vi-
etnamese-American women).
(3) Regions characterized by high rates of pov-
erty also have high mortality for some forms of can-
cer. For example, in Appalachian Kentucky the inci-
dence of lung cancer among white males was 127
per 100,000 in 1992, a rate higher than that for any
ethnic minority group in the United States during
the same period.
(4) Major disparities for other chronic diseases
exist among population groups, with a dispropor-
tionate burden of death and disability from cardio-
vascular disease in racial and ethnic minority and
low-income populations. Compared with rates for the
general population, coronary heart disease mortality
was 40 percent lower for Asian Americans but 40
percent higher for African-Americans.
(5) Minority populations are disproportionately
impacted by diabetes and other chronic diseases.
Hispanics are twice as likely to have diabetes as
non-Hispanic whites; diabetes is the fourth leading
cause of death among Hispanic women and elderly.
African Americans are 1.7 times as likely to have di-
abetes as the general population. More than 15% of
the combined populations of Native Americans and
Alaska Natives have diabetes.
(6) Culturally competent approaches to chronic
disease care are needed to encourage increased par-
ticipation of racial and ethnic minorities and the
medically underserved in chronic disease prevention,
early detection and treatment programs.
SEC. 3. HRSA GRANTS FOR MODEL COMMUNITY CANCER
AND CHRONIC DISEASE CARE AND PREVEN-
TION; HRSA GRANTS FOR PATIENT NAVIGA-
TORS.
Subpart I of part D of title III of the Public Health
Service Act (42 U.S.C. 254b et seq.) is amended by adding
at the end the following:
‘‘SEC. 330I. MODEL COMMUNITY CANCER AND CHRONIC
DISEASE CARE AND PREVENTION; PATIENT
NAVIGATORS.
‘‘(a) MODEL COMMUNITY CANCER
AND CHRONIC
DISEASE CARE AND PREVENTION.—
‘‘(1) IN
GENERAL.—The Secretary, acting
through the Administrator of the Health Resources
and Services Administration, may make grants to
public and nonprofit private health centers (includ-
ing health centers under section 330, Indian Health
Service Centers, and rural health clinics) for the de-
velopment and operation of model programs that—
‘‘(A) provide to individuals of health dis-
parity populations prevention, early detection,
treatment, and appropriate follow-up care serv-
ices for cancer and chronic diseases;
‘‘(B) ensure that the health services are
provided to such individuals in a culturally com-
petent manner; and
‘‘(C) assign patient navigators, in accord-
ance with applicable criteria of the Secretary,
for individuals of health disparity populations
to—
‘‘(i) accomplish, to the extent possible,
the follow-up and diagnosis of an abnormal
finding and the treatment and appropriate
follow-up care of cancer or other chronic
disease; and
‘‘(ii) facilitate access to appropriate
health care services within the health care
system to ensure optimal patient utiliza-
tion of such services.
‘‘(2) OUTREACH
SERVICES.—A condition for
the receipt of a grant under paragraph (1) is that
the applicant involved agree to provide ongoing out-
reach activities while receiving the grant, in a man-
ner that is culturally competent for the health dis-
parity population served by the program, to inform
the public of the services of the model program
under the grant. Such activities shall include facili-
tating access to appropriate health care services and
patient navigators within the health care system to
ensure optimal patient utilization of these services.
‘‘(3) APPLICATION FOR GRANT.—A grant may
be made under paragraph (1) only if an application
for the grant is submitted to the Secretary and the
application is in such form, is made in such manner,
and contains such agreements, assurances, and in-
formation as the Secretary determines to be nec-
essary to carry out this section.
‘‘(4) EVALUATIONS.—
‘‘(A) IN GENERAL.—The Secretary, acting
through the Administrator of the Health Re-
sources and Services Administration, shall, di-
rectly or through grants or contracts, provide
for evaluations to determine which outreach ac-
tivities under paragraph (2) were most effective
in informing the public of the model program
services and to determine the extent to which
such programs were effective in providing cul-
turally competent services to the health dis-
parity population served by the programs.
‘‘(B) DISSEMINATION OF FINDINGS.—The
Secretary shall as appropriate disseminate to
public and private entities the findings made in
evaluations under subparagraph (A).
‘‘(5) 
COORDINATION
WITH
OTHER
PRO-
GRAMS.—The Secretary shall coordinate the pro-
gram under this subsection with the program under
subsection (b), with the program under section
417D, and to the extent practicable, with programs
for prevention centers that are carried out by the
Director of the Centers for Disease Control and Pre-
vention.
‘‘(b) PROGRAM FOR PATIENT NAVIGATORS.—
‘‘(1) IN
GENERAL.—The Secretary, acting
through the Administrator of the Health Resources
and Services Administration, may make grants to
public and nonprofit private health centers (includ-
ing health centers under section 330, Indian Health
Service Centers, and rural health clinics) for the de-
velopment and operation of programs to pay the
costs of such health centers in—
‘‘(A) assigning patient navigators, in ac-
cordance with applicable criteria of the Sec-
retary, for individuals of health disparity popu-
lations for the duration of receiving health serv-
ices from the health centers;
‘‘(B) ensuring that the services provided by
the patient navigators to such individuals in-
clude case management and psychosocial as-
sessment and care or information and referral
to such services;
‘‘(C) ensuring that the patient navigators
provide services to such individuals in a cul-
turally competent manner; and
‘‘(D) developing model practices for patient
navigators, including with respect to—
‘‘(i) coordination of health services,
including 
psychosocial 
assessment 
and
care;
‘‘(ii) appropriate follow-up care, in-
cluding psychosocial assessment and care;
and
‘‘(iii) 
determining 
coverage 
under
health insurance and health plans for all
services.
‘‘(2) OUTREACH
SERVICES.—A condition for
the receipt of a grant under paragraph (1) is that
the applicant involved agree to provide ongoing out-
reach activities while receiving the grant, in a man-
ner that is culturally competent for the health dis-
parity population served by the program, to inform
the public of the services of the model program
under the grant.
‘‘(3) APPLICATION FOR GRANT.—A grant may
be made under paragraph (1) only if an application
for the grant is submitted to the Secretary and the
application is in such form, is made in such manner,
and contains such agreements, assurances, and in-
formation as the Secretary determines to be nec-
essary to carry out this section.
‘‘(4) EVALUATIONS.—
‘‘(A) IN GENERAL.—The Secretary, acting
through the Administrator of the Health Re-
sources and Services Administration, shall, di-
rectly or through grants or contracts, provide
for evaluations to determine the effects of the
services of patient navigators on the individuals
of health disparity populations for whom the
services were provided, taking into account the
matters referred to in paragraph (1)(C).
‘‘(B) DISSEMINATION OF FINDINGS.—The
Secretary shall as appropriate disseminate to
public and private entities the findings made in
evaluations under subparagraph (A).
‘‘(5) 
COORDINATION
WITH
OTHER
PRO-
GRAMS.—The Secretary shall coordinate the pro-
gram under this subsection with the program under
subsection (a) and with the program under section
417D.
‘‘(c) REQUIREMENTS REGARDING FEES.—A condi-
tion for the receipt of a grant under subsection (a)(1) or
(b)(1) is that the program for which the grant is made
have in effect—
‘‘(1) a schedule of fees or payments for the pro-
vision of its services that is consistent with locally
prevailing rates or charges and is designed to cover
its reasonable costs of operation; and
‘‘(2) a corresponding schedule of discounts to
be applied to the payment of such fees or payments,
which discounts are adjusted on the basis of the
ability of the patient to pay.
‘‘(d) MODEL.—Not later than three years after the
date of the enactment of this section, the Secretary shall
develop a peer-reviewed model of systems for the services
provided by this section. The Secretary shall update such
model as may be necessary to ensure that the best prac-
tices are being utilized.
‘‘(e) DURATION
OF GRANT.—The period during
which payments are made to an entity from a grant under
subsection (a)(1) or (b)(1) may not exceed five years. The
provision of such payments are subject to annual approval
by the Secretary of the payments and subject to the avail-
ability of appropriations for the fiscal year involved to
make the payments. This subsection may not be construed
as establishing a limitation on the number of grants under
such subsection that may be made to an entity.
‘‘(f) DEFINITIONS.—For purposes of this section:
‘‘(1) The term ‘culturally competent’, with re-
spect to providing health-related services, means
services that, in accordance with standards and
measures of the Secretary, are designed to effec-
tively and efficiently respond to the cultural and lin-
guistic needs of patients.
‘‘(2) The term ‘appropriate follow-up care’ in-
cludes palliative and end-of-life care.
‘‘(3) The term ‘health disparity population’
means a population where there exists a significant
disparity in the overall rate of disease incidence,
morbidity, mortality, or survival rates in the popu-
lation as compared to the health status of the gen-
eral population. Such term includes—
‘‘(A) racial and ethnic minority groups as
defined in section 1707; and
‘‘(B) medically underserved groups, such
as rural and low-income individuals and individ-
uals with low levels of literacy.
‘‘(4)(A) The term ‘patient navigator’ means an
individual whose functions include—
‘‘(i) assisting and guiding patients with a
symptom or an abnormal finding or diagnosis of
cancer or other chronic disease within the
health care system to accomplish the follow-up
and diagnosis of an abnormal finding as well as
the treatment and appropriate follow-up care of
cancer or other chronic disease; and
‘‘(ii) identifying, anticipating, and helping
patients overcome barriers within the health
care system to ensure prompt diagnostic and
treatment resolution of an abnormal finding of
cancer or other chronic disease.
‘‘(B) Such term includes representatives of the
target health disparity population, such as nurses,
social workers, cancer survivors, and patient advo-
cates.
‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—
‘‘(1) IN GENERAL.—
‘‘(A) MODEL PROGRAMS.—For the purpose
of carrying out subsection (a) (other than the
purpose described in paragraph (2)(A)), there
are authorized to be appropriated such sums as
may be necessary for each of the fiscal years
2003 through 2007.
‘‘(B) PATIENT NAVIGATORS.—For the pur-
pose of carrying out subsection (b) (other than
the purpose described in paragraph (2)(B)),
there are authorized to be appropriated such
sums as may be necessary for each of the fiscal
years 2003 through 2007.
‘‘(C) 
BUREAU
OF
PRIMARY
HEALTH
CARE.—Amounts appropriated under subpara-
graph (A) or (B) shall be administered through
the Bureau of Primary Health Care.
‘‘(2) PROGRAMS IN RURAL AREAS.—
‘‘(A) MODEL PROGRAMS.—For the purpose
of carrying out subsection (a) by making grants
under such subsection for model programs in
rural areas, there are authorized to be appro-
priated such sums as may be necessary for each
of the fiscal years 2003 through 2007.
‘‘(B) PATIENT NAVIGATORS.—For the pur-
pose of carrying out subsection (b) by making
grants under such subsection for programs in
rural areas, there are authorized to be appro-
priated such sums as may be necessary for each
of the fiscal years 2003 through 2007.
‘‘(C) OFFICE
OF
RURAL
HEALTH
POL-
ICY.—Amounts appropriated under subpara-
graph (A) or (B) shall be administered through
the Office of Rural Health Policy.
‘‘(3) RELATION TO OTHER AUTHORIZATIONS.—
Authorizations of appropriations under paragraphs
(1) and (2) are in addition to other authorizations
of appropriations that are available for the purposes
described in such paragraphs.’’.
SEC. 4. NCI GRANTS FOR MODEL COMMUNITY CANCER AND
CHRONIC DISEASE CARE AND PREVENTION;
NCI GRANTS FOR PATIENT NAVIGATORS.
Subpart 1 of part C of title IV of the Public Health
Service Act (42 U.S.C. 285 et seq.) is amended by adding
at the end following section:
‘‘SEC. 417D. MODEL COMMUNITY CANCER AND CHRONIC
DISEASE CARE AND PREVENTION; PATIENT
NAVIGATORS.
‘‘(a) MODEL COMMUNITY CANCER
AND CHRONIC
DISEASE CARE AND PREVENTION.—
‘‘(1) IN GENERAL.—The Director of the Insti-
tute may make grants to eligible entities for the de-
velopment and operation of model programs that—
‘‘(A) provide to individuals of health dis-
parity populations prevention, early detection,
treatment, and appropriate follow-up care serv-
ices for cancer and chronic diseases;
‘‘(B) ensure that the health services are
provided to such individuals in a culturally com-
petent manner; and
‘‘(C) assign patient navigators, in accord-
ance with applicable criteria of the Secretary,
for individuals of health disparity populations
to—
‘‘(i) accomplish, to the extent possible,
the follow-up and diagnosis of an abnormal
finding and the treatment and appropriate
follow-up care of cancer or other chronic
disease; and
‘‘(ii) facilitate access to appropriate
health care services within the health care
system to ensure optimal patient utiliza-
tion of such services.
‘‘(2) ELIGIBLE ENTITIES.—For purposes of this
section, an eligible entity is a designated cancer cen-
ter of the Institute, an academic institution, a hos-
pital, a nonprofit organization, or any other public
or private entity determined to be appropriate by the
Director of the Institute, that provides services de-
scribed in paragraph (1)(A) for cancer or chronic
diseases.
‘‘(3) OUTREACH
SERVICES.—A condition for
the receipt of a grant under paragraph (1) is that
the applicant involved agree to provide ongoing out-
reach activities while receiving the grant, in a man-
ner that is culturally competent for the health dis-
parity population served by the program, to inform
the public of the services of the model program
under the grant. Such activities shall include facili-
tating access to appropriate health care services and
patient navigators within the health care system to
ensure optimal patient utilization of these services.
‘‘(4) APPLICATION FOR GRANT.—A grant may
be made under paragraph (1) only if an application
for the grant is submitted to the Director of the In-
stitute and the application is in such form, is made
in such manner, and contains such agreements, as-
surances, and information as the Director deter-
mines to be necessary to carry out this section.
‘‘(5) EVALUATIONS.—
‘‘(A) IN GENERAL.—The Director of the
Institute, directly or through grants or con-
tracts, shall provide for evaluations to deter-
mine which outreach activities under paragraph
(3) were most effective in informing the public
of the model program services and to determine
the extent to which such programs were effec-
tive in providing culturally competent services
to the health disparity population served by the
programs.
‘‘(B) DISSEMINATION OF FINDINGS.—The
Director of the Institute shall as appropriate
disseminate to public and private entities the
findings made in evaluations under subpara-
graph (A).
‘‘(6) 
COORDINATION
WITH
OTHER
PRO-
GRAMS.—The Secretary shall coordinate the pro-
gram under this subsection with the program under
subsection (b), with the program under section 330I,
and to the extent practicable, with programs for pre-
vention centers that are carried out by the Director
of the Centers for Disease Control and Prevention.
‘‘(b) PROGRAM FOR PATIENT NAVIGATORS.—
‘‘(1) IN GENERAL.—The Director of the Insti-
tute may make grants to eligible entities for the de-
velopment and operation of programs to pay the
costs of such entities in—
‘‘(A) assigning patient navigators, in ac-
cordance with applicable criteria of the Sec-
retary, for individuals of health disparity popu-
lations for the duration of receiving health serv-
ices from the health centers;
‘‘(B) ensuring that the services provided by
the patient navigators to such individuals in-
clude case management and psychosocial as-
sessment and care or information and referral
to such services;
‘‘(C) ensuring that the patient navigators
provide services to such individuals in a cul-
turally competent manner; and
‘‘(D) developing model practices for patient
navigators, including with respect to—
‘‘(i) coordination of health services,
including 
psychosocial 
assessment 
and
care;
‘‘(ii) follow-up services, including psy-
chosocial assessment and care; and
‘‘(iii) 
determining 
coverage 
under
health insurance and health plans for all
services.
‘‘(2) OUTREACH
SERVICES.—A condition for
the receipt of a grant under paragraph (1) is that
the applicant involved agree to provide ongoing out-
reach activities while receiving the grant, in a man-
ner that is culturally competent for the health dis-
parity population served by the program, to inform
the public of the services of the model program
under the grant.
‘‘(3) APPLICATION FOR GRANT.—A grant may
be made under paragraph (1) only if an application
for the grant is submitted to the Director of the In-
stitute and the application is in such form, is made
in such manner, and contains such agreements, as-
surances, and information as the Director deter-
mines to be necessary to carry out this section.
‘‘(4) EVALUATIONS.—
‘‘(A) IN GENERAL.—The Director of the
Institute, directly or through grants or con-
tracts, shall provide for evaluations to deter-
mine the effects of the services of patient navi-
gators on the health disparity population for
whom the services were provided, taking into
account the matters referred to in paragraph
(1)(C).
‘‘(B) DISSEMINATION OF FINDINGS.—The
Director of the Institute shall as appropriate
disseminate to public and private entities the
findings made in evaluations under subpara-
graph (A).
‘‘(5) 
COORDINATION
WITH
OTHER
PRO-
GRAMS.—The Secretary shall coordinate the pro-
gram under this subsection with the program under
subsection (a) and with the program under section
330I.
‘‘(c) REQUIREMENTS REGARDING FEES.—A condi-
tion for the receipt of a grant under subsection (a)(1) or
(b)(1) is that the program for which the grant is made
have in effect—
‘‘(1) a schedule of fees or payments for the pro-
vision of its services that is consistent with locally
prevailing rates or charges and is designed to cover
its reasonable costs of operation; and
‘‘(2) a corresponding schedule of discounts to
be applied to the payment of such fees or payments,
which discounts are adjusted on the basis of the
ability of the patient to pay.
‘‘(d) MODEL.—Not later than three years after the
date of the enactment of this section, the Director of the
Institute shall develop a peer-reviewed model of systems
for the services provided by this section. The Director shall
update such model as may be necessary to ensure that
the best practices are being utilized.
‘‘(e) DURATION
OF GRANT.—The period during
which payments are made to an entity from a grant under
subsection (a)(1) or (b)(1) may not exceed five years. The
provision of such payments are subject to annual approval
by the Director of the Institute of the payments and sub-
ject to the availability of appropriations for the fiscal year
involved to make the payments. This subsection may not
be construed as establishing a limitation on the number
of grants under such subsection that may be made to an
entity.
‘‘(f) DEFINITIONS.—For purposes of this section:
‘‘(1) The term ‘culturally competent’, with re-
spect to providing health-related services, means
services that, in accordance with standards and
measures of the Secretary, are designed to effec-
tively and efficiently respond to the cultural and lin-
guistic needs of patients.
‘‘(2) the term ‘appropriate follow-up care’ in-
cludes palliative and end-of-life care.
‘‘(3) the term ‘health disparity population’
means a population where there exists a significant
disparity in the overall rate of disease incidence,
morbidity, mortality, or survival rates in the popu-
lation as compared to the health status of the gen-
eral population. Such term includes—
‘‘(A) racial and ethnic minority groups as
defined in section 1707; and
‘‘(B) medically underserved groups, such
as rural and low-income individuals and individ-
uals with low levels of literacy.
‘‘(4)(A) the term ‘patient navigator’ means an
individual whose functions include—
‘‘(i) assisting and guiding patients with a
symptom or an abnormal finding or diagnosis of
cancer or other chronic disease within the
health care system to accomplish the follow-up
and diagnosis of an abnormal finding as well as
the treatment and appropriate follow-up care of
cancer or other chronic disease; and
‘‘(ii) identifying, anticipating, and helping
patients overcome barriers within the health
care system to ensure prompt diagnostic and
treatment resolution of an abnormal finding of
cancer or other chronic disease.
‘‘(B) Such term includes representatives of the
target health disparity population, such as nurses,