418 
eliminate knowledge gaps in research to 
improve the prostate cancer research port-
folio of the Federal Government; 
(ii) outline key research questions, 
methodologies, and knowledge gaps; and 
(iii) ensure consistent action, as out-
lined by section 402(b) of the Public 
Health Service Act; 
(E) develop a coordinated message related 
to screening and treatment for prostate cancer 
to be reflected in educational and beneficiary 
materials for Federal health programs as such 
documents are updated; and 
(F) not later than 2 years after the date 
of the establishment of the Prostate Cancer 
Task Force, submit to the Expert Advisory 
Panel to be reviewed and returned within 30 
days, and then within 90 days submitted to 
Congress recommendations— 
(i) regarding any appropriate changes 
to research and health care programs, in-
cluding recommendations to improve the 
research portfolio of the Department of 
Veterans Affairs, Department of Defense, 
National Institutes of Health, and other 
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Federal agencies to ensure that scientif-
ically based strategic planning is imple-
mented in support of research and health 
care program priorities; 
(ii) designed to ensure that the re-
search and health care programs and ac-
tivities of the Department of Veterans Af-
fairs, the Department of Defense, the De-
partment of Health and Human Services, 
and other Federal agencies are free of un-
necessary duplication; 
(iii) regarding public participation in 
decisions relating to prostate cancer re-
search and health care programs to in-
crease the involvement of patient advo-
cates, community organizations, and med-
ical associations representing a broad geo-
graphical area; 
(iv) on how to best disseminate infor-
mation on prostate cancer research and 
progress achieved by health care programs; 
(v) about how to expand partnerships 
between public entities, including Federal 
agencies, and private entities to encourage 
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collaborative, cross-cutting research and 
health care delivery; 
(vi) assessing any cost savings and ef-
ficiencies realized through the efforts iden-
tified and supported in this section and 
recommending expansion of those efforts 
that have proved most promising while also 
ensuring against any conflicts in directives 
from other congressional or statutory man-
dates or enabling statutes; 
(vii) identifying key priority action 
items from among the recommendations; 
and 
(viii) with respect to the level of fund-
ing needed by each agency to implement 
the recommendations contained in the re-
port. 
(3) MEMBERS OF THE PROSTATE CANCER TASK 
FORCE.—The Prostate Cancer Task Force described 
in subsection (a) shall be composed of representa-
tives from such Federal agencies, as each Secretary 
determines necessary, to coordinate a uniform mes-
sage relating to prostate cancer screening and treat-
ment where appropriate, including representatives of 
the following: 
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(A) The Department of Veterans Affairs, 
including representatives of each relevant pro-
gram areas of the Department of Veterans Af-
fairs. 
(B) The Prostate Cancer Research Pro-
gram of the Congressionally Directed Medical 
Research Program of the Department of De-
fense. 
(C) The Department of Health and 
Human Services, including at a minimum rep-
resentatives of the following: 
(i) The National Institutes of Health. 
(ii) National research institutes and 
centers, including the National Cancer In-
stitute, the National Institute of Allergy 
and Infectious Diseases, and the Office of 
Minority Health. 
(iii) The Centers for Medicare & Med-
icaid Services. 
(iv) The Food and Drug Administra-
tion. 
(v) The Centers for Disease Control 
and Prevention. 
(vi) The Agency for Healthcare Re-
search and Quality. 
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(vii) The Health Resources and Serv-
ices Administration. 
(4) APPOINTING EXPERT ADVISORY PANELS.— 
The Prostate Cancer Task Force shall appoint ex-
pert advisory panels, as determined appropriate, to 
provide input and concurrence from individuals and 
organizations from the medical, prostate cancer pa-
tient and advocate, research, and delivery commu-
nities with expertise in prostate cancer diagnosis, 
treatment, and research, including practicing urolo-
gists, primary care providers, and others and indi-
viduals with expertise in education and outreach to 
underserved populations affected by prostate cancer. 
(5) MEETINGS.—The Prostate Cancer Task 
Force shall convene not less than twice a year, or 
more frequently as the Secretary determines to be 
appropriate. 
(6) SUBMISSION
OF
RECOMMENDATIONS
TO 
CONGRESS.—The Secretary of Veterans Affairs shall 
submit to Congress any recommendations submitted 
to the Secretary under paragraph (2)(E). 
(7) FEDERAL ADVISORY COMMITTEE ACT.— 
(A) IN GENERAL.—Except as provided in 
subparagraph (B), the Federal Advisory Com-
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mittee Act (5 U.S.C. App.) shall apply to the 
Prostate Cancer Task Force. 
(B) EXCEPTION.—Section 14(a)(2)(B) of 
such Act (relating to the termination of advi-
sory committees) shall not apply to the Prostate 
Cancer Task Force. 
(8) SUNSET DATE.—The Prostate Cancer Task 
Force shall terminate at the end of fiscal year 2019. 
(d) PROSTATE CANCER RESEARCH.— 
(1) RESEARCH COORDINATION.—The Secretary 
of Veterans Affairs, in coordination with the Secre-
taries of Defense and of Health and Human Serv-
ices, shall establish and carry out a program to co-
ordinate and intensify prostate cancer research as 
needed. Specifically, such research program shall— 
(A) develop advances in diagnostic and 
prognostic methods and tests, including bio-
markers and an improved prostate cancer 
screening blood test, including improvements or 
alternatives to the prostate specific antigen test 
and additional tests to distinguish indolent from 
aggressive disease; 
(B) better understand the etiology of the 
disease (including an analysis of lifestyle factors 
proven to be involved in higher rates of prostate 
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cancer, such as obesity and diet, and in dif-
ferent ethnic, racial, and socioeconomic groups, 
such as the African-American, Latino or His-
panic, and American Indian populations and 
men with a family history of prostate cancer) to 
improve prevention efforts; 
(C) expand basic research into prostate 
cancer, including studies of fundamental molec-
ular and cellular mechanisms; 
(D) identify and provide clinical testing of 
novel agents for the prevention and treatment 
of prostate cancer; 
(E) establish clinical registries for prostate 
cancer; 
(F) use the National Institute of Bio-
medical Imaging and Bioengineering and the 
National Cancer Institute for assessment of ap-
propriate imaging modalities; and 
(G) address such other matters relating to 
prostate cancer research as may be identified by 
the Federal agencies participating in the pro-
gram under this section. 
(2) PROSTATE
CANCER
ADVISORY
BOARD.— 
There is established in the Office of the Chief Sci-
entist of the Food and Drug Administration a Pros-
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tate Cancer Scientific Advisory Board. Such board 
shall be responsible for accelerating real-time shar-
ing of the latest research data and accelerating 
movement of new medicines to patients. 
(3) UNDERSERVED
MINORITY
GRANT
PRO-
GRAM.—In carrying out such program, the Secretary 
shall— 
(A) award grants to eligible entities to 
carry out components of the research outlined 
in paragraph (1); 
(B) integrate and build upon existing 
knowledge gained from comparative effective-
ness research; and 
(C) recognize and address— 
(i) the racial and ethnic disparities in 
the incidence and mortality rates of pros-
tate cancer and men with a family history 
of prostate cancer; 
(ii) any barriers in access to care and 
participation in clinical trials that are spe-
cific to racial, ethnic, and other under-
served minorities and men with a family 
history of prostate cancer; 
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(iii) needed outreach and educational 
efforts to raise awareness in these commu-
nities; and 
(iv) appropriate access and utilization 
of imaging modalities. 
(e) TELEHEALTH
AND
RURAL
ACCESS
PILOT 
PROJECT.— 
(1) IN GENERAL.—The Secretary of Veterans 
Affairs, the Secretary of Defense, and the Secretary 
of Health and Human Services (in this section re-
ferred to as the ‘‘Secretaries’’) shall establish 4-year 
telehealth pilot projects for the purpose of analyzing 
the clinical outcomes and cost effectiveness associ-
ated with telehealth services in a variety of geo-
graphic areas that contain high proportions of medi-
cally underserved populations, including African- 
Americans, Latino or Hispanic, American Indians/ 
Alaska Natives, and those in rural areas. Such 
projects shall promote efficient use of specialist care 
through better coordination of primary care and 
physician extender teams in underserved areas and 
more effectively employ tumor boards to better coun-
sel patients. 
(2) ELIGIBLE ENTITIES.— 
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(A) IN
GENERAL.—The Secretaries shall 
select eligible entities to participate in the pilot 
projects under this section. 
(B) PRIORITY.—In selecting eligible enti-
ties to participate in the pilot projects under 
this section, the Secretaries shall give priority 
to such entities located in medically under-
served areas, particularly those that include Af-
rican-Americans, Latinos and Hispanics, and 
facilities of the Indian Health Service, including 
Indian Health Service operated facilities, trib-
ally operated facilities, and Urban Indian Clin-
ics, and those in rural areas. 
(3) 
EVALUATION.—The 
Secretaries 
shall, 
through the pilot projects, evaluate— 
(A) the effective and economic delivery of 
care in diagnosing and treating prostate cancer 
with the use of telehealth services in medically 
underserved and tribal areas including collabo-
rative uses of health professionals and integra-
tion of the range of telehealth and other tech-
nologies; 
(B) the effectiveness of improving the ca-
pacity of nonmedical providers and nonspecial-
ized medical providers to provide health services 
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for prostate cancer in medically underserved 
and tribal areas, including the exploration of in-
novative medical home models with collabora-
tion between urologists, other relevant medical 
specialists, including oncologists, radiologists, 
and primary care teams and coordination of 
care through the efficient use of primary care 
teams and physician extenders; and 
(C) the effectiveness of using telehealth 
services to provide prostate cancer treatment in 
medically underserved areas, including the use 
of tumor boards to facilitate better patient 
counseling. 
(4) REPORT.—Not later than 12 months after 
the completion of the pilot projects under this sub-
section, the Secretaries shall submit to Congress a 
report describing the outcomes of such pilot projects, 
including any cost savings and efficiencies realized, 
and providing recommendations, if any, for expand-
ing the use of telehealth services. 
(f) EDUCATION AND AWARENESS.— 
(1) IN GENERAL.—The Secretary of Veterans 
Affairs shall develop a national education campaign 
for prostate cancer. Such campaign shall involve the 
use of written educational materials and public serv-
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ice announcements consistent with the findings of 
the Prostate Cancer Task Force under subsection 
(c), that are intended to encourage men to seek 
prostate cancer screening when appropriate. 
(2) RACIAL DISPARITIES AND THE POPULATION 
OF
MEN
WITH
A
FAMILY
HISTORY
OF
PROSTATE 
CANCER.—In developing the national campaign 
under paragraph (1), the Secretary shall ensure that 
such educational materials and public service an-
nouncements are more readily available in commu-
nities experiencing racial disparities in the incidence 
and mortality rates of prostate cancer and by men 
of any race classification with a family history of 
prostate cancer. 
(3) GRANTS.—In carrying out the national 
campaign under this section, the Secretary shall 
award grants to nonprofit private entities to enable 
such entities to test alternative outreach and edu-
cation strategies. 
(g) AUTHORIZATION OF APPROPRIATIONS.— 
(1) IN GENERAL.—There is authorized to be 
appropriated to carry out this section for the period 
of fiscal years 2015 through 2019 an amount equal 
to the savings described in paragraph (2). 
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(2) 
CORRESPONDING
REDUCTION.—The 
amount authorized to be appropriated by provisions 
of law other than this section for the period of fiscal 
years 2015 through 2019 for Federal research and 
health care program activities related to prostate 
cancer is reduced by the amount of Federal savings 
projected to be achieved over such period by imple-
mentation of subsection (c)(2)(C) of this section. 
SEC. 703. IMPROVED MEDICAID COVERAGE FOR CERTAIN 
BREAST AND CERVICAL CANCER PATIENTS 
IN THE TERRITORIES. 
(a) ELIMINATION OF FUNDING LIMITATIONS.— 
(1) IN GENERAL.—Section 1108(g)(4) of the 
Social Security Act (42 U.S.C. 1308(g)(4)) is 
amended by adding at the end the following: ‘‘With 
respect to fiscal years beginning with fiscal year 
2015, payment for medical assistance for individuals 
who are eligible for such assistance only on the basis 
of section 1902(a)(10)(A)(ii)(XVIII) shall not be 
taken into account in applying subsection (f) (as in-
creased in accordance with paragraphs (1), (2), (3), 
and (5) of this subsection) to such commonwealth or 
territory for such fiscal year.’’. 
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(2) TECHNICAL AMENDMENT.—Such section is 
further amended by striking ‘‘(3), and (4)’’ and in-
serting ‘‘(3), and (5)’’. 
(b) APPLICATION OF ENHANCED FMAP FOR HIGH-
EST STATE.—Section 1905(b) of such Act (42 U.S.C. 
1396d(b)) is amended by adding at the end the following: 
‘‘Notwithstanding the first sentence of this subsection, 
with respect to medical assistance described in clause (4) 
of such sentence that is furnished in Puerto Rico, the 
United States Virgin Islands, Guam, the Commonwealth 
of the Northern Mariana Islands, or American Samoa in 
a fiscal year, the Federal medical assistance percentage 
is equal to the highest such percentage applied under such 
clause for such fiscal year for any of the 50 States or the 
District of Columbia that provides such medical assistance 
for any portion of such fiscal year.’’ 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to payment for medical assistance 
for items and services furnished on or after October 1, 
2014. 
SEC. 704. CANCER PREVENTION AND TREATMENT DEM-
ONSTRATION FOR ETHNIC AND RACIAL MI-
NORITIES. 
(a) DEMONSTRATION.— 
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(1) IN GENERAL.—The Secretary of Health and 
Human Services (in this section referred to as the 
‘‘Secretary’’) shall conduct demonstration projects 
(in this section referred to as ‘‘demonstration 
projects’’) for the purpose of developing models and 
evaluating methods that— 
(A) improve the quality of items and serv-
ices provided to target individuals in order to 
facilitate reduced disparities in early detection 
and treatment of cancer; 
(B) improve clinical outcomes, satisfaction, 
quality of life, appropriate use of items and 
services covered under the Medicare Program 
under title XVIII of the Social Security Act (42 
U.S.C. 1395 et seq.), and referral patterns with 
respect to target individuals with cancer; 
(C) eliminate disparities in the rate of pre-
ventive cancer screening measures, such as Pap 
smears, prostate cancer screenings, colon cancer 
screenings, breast cancer screenings, and com-
puted tomography (CT) scans, for lung cancer 
among target individuals; 
(D) promote collaboration with community- 
based organizations to ensure cultural com-
petency of health care professionals and lin-
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guistic access for target individuals who are 
persons with limited-English proficiency; and 
(E) encourage the incorporation of commu-
nity health workers to increase the efficiency 
and appropriateness of cancer screening pro-
grams. 
(2) COMMUNITY HEALTH WORKER DEFINED.— 
In this section, the term ‘‘community health worker’’ 
includes a community health advocate, a lay health 
worker, a community health representative, a peer 
health promotor, a community health outreach work-
er, and a promotore de salud, who promotes health 
or nutrition within the community in which the indi-
vidual resides. 
(3) TARGET
INDIVIDUAL
DEFINED.—In this 
section, the term ‘‘target individual’’ means an indi-
vidual of a racial and ethnic minority group, as de-
fined in section 1707(g)(1) of the Public Health 
Service Act (42 U.S.C. 300u–6(g)(1)), who is enti-
tled to benefits under part A, and enrolled under 
part B, of title XVIII of the Social Security Act. 
(b) PROGRAM DESIGN.— 
(1) INITIAL DESIGN.—Not later than 1 year 
after the date of the enactment of this Act, the Sec-
retary shall evaluate best practices in the private 
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sector, community programs, and academic research 
of methods that reduce disparities among individuals 
of racial and ethnic minority groups in the preven-
tion and treatment of cancer and shall design the 
demonstration projects based on such evaluation. 
(2) NUMBER AND PROJECT AREAS.—Not later 
than 2 years after the date of the enactment of this 
Act, the Secretary shall implement at least nine 
demonstration projects, including the following: 
(A) Two projects, each of which shall tar-
get different ethnic subpopulations, for each of 
the four following major racial and ethnic mi-
nority groups: 
(i) American Indians and Alaska Na-
tives, Eskimos and Aleuts. 
(ii) Asian-Americans. 
(iii) Blacks/African-Americans. 
(iv) Latinos or Hispanics. 
(v) Native Hawaiians and other Pa-
cific Islanders. 
(B) One project within the Pacific Islands 
or United States insular areas. 
(C) At least one project each in a rural 
area and inner-city area. 
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(3) EXPANSION
OF
PROJECTS; IMPLEMENTA-
TION
OF
DEMONSTRATION
PROJECT
RESULTS.—If 
the initial report under subsection (c) contains an 
evaluation that demonstration projects— 
(A) reduce expenditures under the Medi-
care Program under title XVIII of the Social 
Security Act (42 U.S.C. 1395 et seq.); or 
(B) do not increase expenditures under the 
Medicare Program and reduce racial and ethnic 
health disparities in the quality of health care 
services provided to target individuals and in-
crease satisfaction of Medicare beneficiaries and 
health care providers; 
the Secretary shall continue the existing demonstra-
tion projects and may expand the number of dem-
onstration projects. 
(c) REPORT TO CONGRESS.— 
(1) IN GENERAL.—Not later than 2 years after 
the date the Secretary implements the initial dem-
onstration projects, and biannually thereafter, the 
Secretary shall submit to Congress a report regard-
ing the demonstration projects. 
(2) CONTENTS OF REPORT.—Each report under 
paragraph (1) shall include the following: 
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(A) A description of the demonstration 
projects. 
(B) An evaluation of— 
(i) the cost effectiveness of the dem-
onstration projects; 
(ii) the quality of the health care serv-
ices provided to target individuals under 
the demonstration projects; and 
(iii) beneficiary and health care pro-
vider satisfaction under the demonstration 
projects. 
(C) Any other information regarding the 
demonstration projects that the Secretary de-
termines to be appropriate. 
(d) WAIVER AUTHORITY.—The Secretary shall waive 
compliance with the requirements of title XVIII of the So-
cial Security Act (42 U.S.C. 1395 et seq.) to such extent 
and for such period as the Secretary determines is nec-
essary to conduct demonstration projects. 
SEC. 705. REDUCING CANCER DISPARITIES WITHIN MEDI-
CARE. 
(a) DEVELOPMENT OF MEASURES OF DISPARITIES 
IN QUALITY OF CANCER CARE.— 
(1) DEVELOPMENT OF MEASURES.—The Sec-
retary of Health and Human Services (in this sec-
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tion referred to as the ‘‘Secretary’’) shall enter into 
an agreement with an entity that specializes in de-
veloping quality measures for cancer care under 
which the entity shall develop a uniform set of meas-
ures to evaluate disparities in the quality of cancer 
care and annually update such set of measures. 
(2) MEASURES TO BE INCLUDED.—Such set of 
measures shall include, with respect to the treatment 
of cancer, measures of patient outcomes, the process 
for delivering medical care related to such treat-
ment, patient counseling and engagement in deci-
sionmaking, patient experience of care, resource use, 
and practice capabilities, such as care coordination. 
(b) ESTABLISHMENT OF REPORTING PROCESS.— 
(1) IN GENERAL.—The Secretary shall establish 
a reporting process that requires and provides for a 
method for health care providers specified under 
paragraph (2) to submit to the Secretary and make 
public data on the performance of such providers 
during each reporting period through use of the 
measures developed pursuant to subsection (a). Such 
data shall be submitted in a form and manner and 
at a time specified by the Secretary. 
(2) SPECIFICATION OF PROVIDERS TO REPORT 
ON
MEASURES.—The Secretary shall specify the 
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classes of Medicare providers of services and sup-
pliers, including hospitals, cancer centers, physi-
cians, primary care providers, and specialty pro-
viders, that will be required under such process to 
publicly report on the measures specified under sub-
section (a). 
(3) ASSESSMENT
OF
CHANGES.—Under such 
reporting process, the Secretary shall establish a for-
mat that assesses changes in both the absolute and 
relative disparities in cancer care over time. These 
measures shall be presented in an easily comprehen-
sible format, such as those presented in the final 
publications relating to Healthy People 2010 or the 
National Healthcare Disparities Report. 
(4) INITIAL IMPLEMENTATION.—The Secretary 
shall implement the reporting process under this 
subsection for reporting periods beginning not later 
than 6 months after the date that measures are first 
established under subsection (a). 
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Subtitle 
B—Viral 
Hepatitis 
and 
Liver Cancer Control and Pre-
vention 
SEC. 711. VIRAL HEPATITIS AND LIVER CANCER CONTROL 
AND PREVENTION. 
(a) SHORT TITLE.—This subtitle may be cited as the 
‘‘Viral Hepatitis and Liver Cancer Control and Prevention 
Act of 2014’’. 
(b) FINDINGS.—Congress finds the following: 
(1) Approximately 5,300,000 Americans are 
chronically infected with the hepatitis B virus (re-
ferred to in this section as ‘‘HBV’’), the hepatitis C 
virus (referred to in this section as ‘‘HCV’’), or 
both. 
(2) In the United States, chronic HBV and 
HCV are the most common cause of liver cancer, 
one of the most lethal and fastest growing cancers 
in this country. It is the most common cause of 
chronic liver disease, liver cirrhosis, and the most 
common indication for liver transplantation. At least 
15,000 deaths per year in the United States can be 
attributed to chronic HBV and HCV. Chronic HCV 
is also a leading cause of death in Americans living 
with HIV/AIDS, many of those living with HIV/ 
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AIDS are coinfected with chronic HBV, chronic 
HCV, or both. 
(3) According to the Centers for Disease Con-
trol and Prevention (referred to in this section as 
the ‘‘CDC’’), approximately 2 percent of the popu-
lation of the United States is living with chronic 
HBV, chronic HCV, or both. The CDC has recog-
nized HCV as the Nation’s most common chronic 
bloodborne virus infection and HBV as the deadliest 
vaccine-preventable disease. 
(4) HBV is easily transmitted and is 100 times 
more infectious than HIV. According to the CDC, 
HBV is transmitted through contact with infectious 
blood, semen, or other body fluids. HCV is trans-
mitted by contact with infectious blood, particularly 
through percutaneous exposures (i.e. puncture 
through the skin). 
(5) The CDC conservatively estimates that in 
2010 approximately 17,000 Americans were newly 
infected with HCV and more than 35,000 Americans 
were newly infected with HBV. These estimates 
could be much higher due to many reasons, includ-
ing lack of screening education and awareness, and 
perceived marginalization of the populations at risk. 
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(6) In 2012, CDC released new guidelines rec-
ommending every person born between 1945 and 
1965 receive a one-time test. Among the estimated 
102 million (1.6 million chronically HCV-infected) 
eligible for screening, birth-cohort screening leads to 
84,000 fewer cases of decompensated cirrhosis, 
46,000 fewer cases of hepatocellular carcinoma, 
10,000 fewer liver transplants, and 78,000 fewer 
HCV-related deaths gained versus risk-based screen-
ing. 
(7) In 2013, the United States Preventive Task 
Force (USPSTF) issued a Grade B rating for 
screening for the hepatitis C virus (HCV) infection 
in persons at high risk for infection and adults born 
between 1945 and 1965. In 2014, the USPSTF 
issued a Grade B for screening for the hepatitis B 
virus (HBV) in persons at high-risk of hepatitis B 
infection. In 2009, the USPSTF issued a Grade A 
for screening pregnant women for the hepatitis B 
virus (HBV) during their first prenatal visit. 
(8) There were 35 outbreaks (19 of HBV, 16 
of HCV) reported to CDC for investigation from 
2008 through 2012 related to health care acquired 
infection of HBV and HCV, 33 of which occurred in 
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nonhospital settings. There were more than 99,975 
patients potentially exposed to one of the viruses. 
(9) Chronic HBV and chronic HCV usually do 
not cause symptoms early in the course of the dis-
ease, but after many years of a clinically ‘‘silent’’ 
phase, CDC estimates show more than 33 percent of 
infected individuals will develop cirrhosis, end-stage 
liver disease, or liver cancer. Since most individuals 
with chronic HBV, HCV, or both are unaware of 
their infection, they do not know to take precautions 
to prevent the spread of their infection and can un-
knowingly exacerbate their own disease progression. 
(10) HBV and HCV disproportionately affect 
certain populations in the United States. Although 
representing only 6 percent of the population, Asian- 
Americans and Pacific Islanders account for over 
half of the 1,400,000 domestic chronic HBV cases. 
Baby boomers (those born between 1945 and 1965) 
account for more than half of domestic chronic hepa-
titis C cases. In addition, African-Americans, 
Latinos (Latinas), and American Indian/Native 
Alaskans are among the groups which have dis-
proportionately high rates of HBV and/or HCV in-
fections in the United States. 
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(11) For both chronic HBV and chronic HCV, 
behavioral changes can slow disease progression if 
diagnosis is made early. Early diagnosis, which is 
determined through simple blood tests, can reduce 
the risk of transmission and disease progression 
through education and vaccination of household 
members and other susceptible persons at risk. 
(12) Advancements have led to the development 
of improved diagnostic tests for viral hepatitis. 
These tests, including rapid, point of care testing 
and others in development, can facilitate testing, no-
tification of results and post-test counseling, and re-
ferral to care at the time of the testing visit. In par-
ticular, these tests are also advantageous because 
they can be used simultaneously with HIV rapid 
testing for persons at risk for both HCV and HIV 
infections. 
(13) For those chronically infected with HBV 
or HCV, regular monitoring can lead to the early de-
tection of liver cancer at a stage where a cure is still 
possible. Liver cancer is the second deadliest cancer 
in the United States; however, liver cancer has re-
ceived little funding for research, prevention, or 
treatment. 
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(14) Treatment for chronic HCV can eradicate 
the disease in approximately 75 percent of those cur-
rently treated. The treatment of chronic HBV can 
effectively suppress viral replication in the over-
whelming majority (over 80 percent) of those treat-
ed, thereby reducing the risk of transmission and 
progression to liver scarring or liver cancer, even 
though a complete cure is much less common than 
for HCV. 
(15) To combat the viral hepatitis epidemic in 
the United States, in May 2011, the Department of 
Health and Human Services released ‘‘Combating 
the Silent Epidemic of Viral Hepatitis: Action Plan 
for the Prevention, Care & Treatment of Viral Hepa-
titis’’ (hereafter referred to as the HHS Action 
Plan). The Institute of Medicine (IOM) of the Na-
tional Academies produced a 2010 report on the 
Federal response to HBV and HCV titled: ‘‘Hepa-
titis and Liver Cancer: A National Strategy for Pre-
vention and Control of Hepatitis B and C’’. These 
recommendations and guidelines provide a frame-
work for HBV and HCV prevention, education, con-
trol, research, and medical management programs. 
(16) The annual health care costs attributable 
to HBV and HCV in the United States are signifi-
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cant. For HBV, it is estimated to be approximately 
$2,500,000,000 ($2,000 per infected person). In 
2000, the lifetime cost of HBV—-before the avail-
ability of most current therapies—-was approxi-
mately $80,000 per chronically infected person, to-
taling more than $100,000,000,000. For HCV, med-
ical costs for patients are expected to increase from 
$30,000,000,000 in 2009 to over $85,000,000,000 
in 2024. Avoiding these costs by screening and diag-
nosing individuals earlier—and connecting them to 
appropriate treatment and care, will save lives and 
critical health care dollars. Currently, without a 
comprehensive screening, testing, and diagnosis pro-
gram, most patients are diagnosed too late when 
they need a liver transplant costing at least 
$314,000 for uncomplicated cases or when they have 
liver cancer or end stage liver disease which costs 
$30,980 to $110,576 per hospital admission. As 
health care costs continue to grow, it is critical that 
the Federal Government invests in effective mecha-
nisms to avoid documented cost drivers. 
(17) According to the IOM report in 2010 (de-
scribed in paragraph (15)), chronic HBV and HCV 
infections cause substantial morbidity and mortality 
despite being preventable and treatable. Deficiencies 
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in the implementation of established guidelines for 
the prevention, diagnosis, and medical management 
of chronic HBV and HCV infections perpetuate per-
sonal and economic burdens. Existing grants are not 
sufficient for the scale of the health burden pre-
sented by HBV and HCV. 
(18) Screening and testing for HBV and HCV 
is aligned with the Healthy People 2020 goal to in-
crease immunization rates and reduce preventable 
infectious diseases. Awareness of disease and access 
to prevention and treatment remain essential compo-
nents for reducing infectious disease transmission. 
(19) Federal support is necessary to increase 
knowledge and awareness of HBV and HCV and to 
assist State and local prevention and control efforts 
in reducing the morbidity and mortality of these 
epidemics. 
(20) The Secretary of Health and Human Serv-
ices has the discretion to carry out this Act directly 
and through whichever of the agencies of the Public 
Health Service the Secretary determines to be ap-
propriate, which may (in the Secretary’s discretion) 
include the Centers for Disease Control and Preven-
tion, the Health Resources and Services Administra-
tion, the Substance Abuse and Mental Health Serv-
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ices Administration, the National Institutes of 
Health (including the National Institute on Minority 
Health and Health Disparities), and other agencies 
of such Service. 
(c) BIENNIAL ASSESSMENT OF HHS HEPATITIS B 
AND HEPATITIS C PREVENTION, EDUCATION, RESEARCH, 
AND MEDICAL MANAGEMENT PLAN.—Title III of the 
Public Health Service Act (42 U.S.C. 241 et seq.) is 
amended— 
(1) by striking section 317N (42 U.S.C. 247b– 
15); and 
(2) by adding at the end the following: 
‘‘PART W—BIENNIAL ASSESSMENT OF HHS HEPA-
TITIS B AND HEPATITIS C PREVENTION, EDU-
CATION, RESEARCH, AND MEDICAL MANAGE-
MENT PLAN 
‘‘SEC. 399NN. BIENNIAL UPDATE OF THE PLAN. 
‘‘(a) IN GENERAL.—The Secretary shall conduct a bi-
ennial assessment of the Secretary’s plan for the preven-
tion, control, and medical management of, and education 
and research relating to, hepatitis B and hepatitis C, for 
the purposes of— 
‘‘(1) incorporating into such plan new knowl-
edge or observations relating to hepatitis B and hep-
atitis C (such as knowledge and observations that 
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may be derived from clinical, laboratory, and epide-
miological research and disease detection, preven-
tion, and surveillance outcomes); 
‘‘(2) addressing gaps in the coverage or effec-
tiveness of the plan; and 
‘‘(3) evaluating and, if appropriate, updating 
recommendations, guidelines, or educational mate-
rials of the Centers for Disease Control and Preven-
tion or the National Institutes of Health for health 
care providers or the public on viral hepatitis in 
order to be consistent with the plan. 
‘‘(b) PUBLICATION OF NOTICE OF ASSESSMENTS.— 
Not later than October 1 of the first even-numbered year 
beginning after the date of the enactment of this part, 
and October 1 of each even-numbered year thereafter, the 
Secretary shall publish in the Federal Register a notice 
of the results of the assessments conducted under para-
graph (1). Such notice shall include— 
‘‘(1) a description of any revisions to the plan 
referred to in subsection (a) as a result of the as-
sessment; 
‘‘(2) an explanation of the basis for any such 
revisions, including the ways in which such revisions 
can reasonably be expected to further promote the 
original goals and objectives of the plan; and 
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‘‘(3) in the case of a determination by the Sec-
retary that the plan does not need revision, an expla-
nation of the basis for such determination. 
‘‘SEC. 399NN–1. ELEMENTS OF PROGRAM. 
‘‘(a) EDUCATION AND AWARENESS PROGRAMS.—The 
Secretary, acting through the Director of the Centers for 
Disease Control and Prevention, the Administrator of the 
Health Resources and Services Administration, and the 
Administrator of the Substance Abuse and Mental Health 
Services Administration, and in accordance with the plan 
referred to in section 399NN(a), shall implement pro-
grams to increase awareness and enhance knowledge and 
understanding of hepatitis B and hepatitis C. Such pro-
grams shall include— 
‘‘(1) the conduct of culturally and language ap-
propriate health education in primary and secondary 
schools, college campuses, public awareness cam-
paigns, and community outreach activities (especially 
to the ethnic communities with high rates of chronic 
hepatitis B and chronic hepatitis C and other high- 
risk groups) to promote public awareness and knowl-
edge about the value of hepatitis A and hepatitis B 
immunization, risk factors, the transmission and 
prevention of hepatitis B and hepatitis C, the value 
of screening for the early detection of hepatitis B 
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to the special needs of individuals infected with hep-
atitis B and hepatitis C, such as the importance of 
prevention and early intervention, regular moni-
toring, the recognition of psychosocial needs, appro-
priate treatment, and liver cancer screening) for in-
dividuals providing hepatitis B and hepatitis C coun-
seling; and 
‘‘(7) support for the implementation curricula 
described in paragraph (6) by State and local public 
health agencies. 
‘‘(b) IMMUNIZATION, PREVENTION, AND CONTROL 
PROGRAMS.— 
‘‘(1) IN
GENERAL.—The Secretary, acting 
through the Director of the Centers for Disease 
Control and Prevention, shall support the integra-
tion of activities described in paragraph (3) into ex-
isting clinical and public health programs at State, 
local, territorial, and tribal levels (including commu-
nity health clinics, programs for the prevention and 
treatment of HIV/AIDS, sexually transmitted dis-
eases, and substance abuse, and programs for indi-
viduals in correctional settings). 
‘‘(2) COORDINATION
OF
DEVELOPMENT
OF 
FEDERAL SCREENING GUIDELINES.— 
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‘‘(A) REFERENCES.—For purposes of this 
subsection, the term ‘CDC Director’ means the 
Director of the Centers for Disease Control and 
Prevention, and the term ‘AHRQ Director’ 
means 
the 
Director 
of 
the 
Agency 
for 
Healthcare Research and Quality. 
‘‘(B) AGENCY
FOR
HEALTHCARE
RE-
SEARCH
AND
QUALITY.—Due to the rapidly 
evolving standard of care associated with diag-
nosing and treating viral hepatitis infection, the 
AHRQ Director shall convene the Preventive 
Services Task Force under section 915(a) of 
the Public Health Service Act to review its rec-
ommendation for screening for HBV and HCV 
infection every 3 years. 
‘‘(3) ACTIVITIES.— 
‘‘(A) VOLUNTARY TESTING PROGRAMS.— 
‘‘(i) IN
GENERAL.—The Secretary 
shall establish a mechanism by which to 
support and promote the development of 
State, local, territorial, and tribal vol-
untary hepatitis B and hepatitis C testing 
programs to screen the high-prevalence 
populations to aid in the early identifica-
tion of chronically infected individuals. 
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‘‘(ii) CONFIDENTIALITY OF THE TEST 
RESULTS.—The Secretary shall prohibit 
the use of the results of a hepatitis B or 
hepatitis C test conducted by a testing pro-
gram developed or supported under this 
subparagraph for any of the following: 
‘‘(I) Issues relating to health in-
surance. 
‘‘(II) To screen or determine 
suitability for employment. 
‘‘(III) To discharge a person 
from employment. 
‘‘(B) COUNSELING REGARDING VIRAL HEP-
ATITIS.—The Secretary shall support State, 
local, territorial, and tribal programs in a wide 
variety of settings, including those providing 
primary and specialty health care services in 
nonprofit private and public sectors, to— 
‘‘(i) provide individuals with ongoing 
risk factors for hepatitis B and hepatitis C 
infection with client-centered education 
and counseling which concentrates on— 
‘‘(I) promoting testing of individ-
uals that have been exposed to their 
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blood, family members, and their sex-
ual partners; and 
‘‘(II) changing behaviors that 
place individuals at risk for infection; 
‘‘(ii) provide individuals chronically in-
fected with hepatitis B or hepatitis C with 
education, health information, and coun-
seling to reduce their risk of— 
‘‘(I) dying from end-stage liver 
disease and liver cancer; and 
‘‘(II) transmitting viral hepatitis 
to others; and 
‘‘(iii) provide women chronically in-
fected with hepatitis B or hepatitis C who 
are pregnant or of childbearing age with 
culturally and language appropriate health 
information, such as how to prevent hepa-
titis B perinatal infection, and to alleviate 
fears associated with pregnancy or raising 
a family. 
‘‘(C) IMMUNIZATION.—The Secretary shall 
support State, local, territorial, and tribal ef-
forts to expand the current vaccination pro-
grams to protect every child in the country and 
all susceptible adults, particularly those infected 
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with hepatitis C and high-prevalence ethnic 
populations and other high-risk groups, from 
the risks of acute and chronic hepatitis B infec-
tion by— 
‘‘(i) ensuring continued funding for 
hepatitis B vaccination for all children 19 
years of age or younger through the Vac-
cines for Children Program; 
‘‘(ii) ensuring that the recommenda-
tions of the Advisory Committee on Immu-
nization Practices are followed regarding 
the birth dose of hepatitis B vaccinations 
for newborns; 
‘‘(iii) requiring proof of hepatitis B 
vaccination for entry into public or private 
daycare, preschool, elementary school, sec-
ondary school, and institutions of higher 
education; 
‘‘(iv) expanding the availability of 
hepatitis B vaccination for all susceptible 
adults to protect them from becoming 
acutely or chronically infected, including 
ethnic and other populations with high 
prevalence rates of chronic hepatitis B in-
fection; 
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‘‘(v) expanding the availability of hep-
atitis B vaccination for all susceptible 
adults, particularly those in their reproduc-
tive age (women and men less than 45 
years of age), to protect them from the 
risk of hepatitis B infection; 
‘‘(vi) ensuring the vaccination of indi-
viduals infected, or at risk for infection, 
with hepatitis C against hepatitis A, hepa-
titis B, and other infectious diseases, as 
appropriate, for which such individuals 
may be at increased risk; and 
‘‘(vii) ensuring the vaccination of indi-
viduals infected, or at risk for infection, 
with hepatitis B against hepatitis A virus 
and other infectious diseases, as appro-
priate, for which such individuals may be 
at increased risk. 
‘‘(D) MEDICAL REFERRAL.—The Secretary 
shall support State, local, territorial, and tribal 
programs that support— 
‘‘(i) referral of persons chronically in-
fected with hepatitis B or hepatitis C— 
‘‘(I) for medical evaluation to de-
termine 
the 
appropriateness 
for 
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antiviral treatment to reduce the risk 
of progression to cirrhosis and liver 
cancer; and 
‘‘(II) for ongoing medical man-
agement including regular monitoring 
of liver function and screening for 
liver cancer; and 
‘‘(ii) referral of persons infected with 
acute or chronic hepatitis B infection or 
acute or chronic hepatitis C infection for 
drug and alcohol abuse treatment where 
appropriate. 
‘‘(4) INCREASED SUPPORT FOR ADULT VIRAL 
HEPATITIS COORDINATORS.—The Secretary, acting 
through the Director of the Centers for Disease 
Control and Prevention, shall provide increased sup-
port to Adult Viral Hepatitis Coordinators in State, 
local, territorial, and tribal health departments in 
order to enhance the additional management, net-
working, and technical expertise needed to ensure 
successful integration of hepatitis B and hepatitis C 
prevention and control activities into existing public 
health programs. 
‘‘(c) EPIDEMIOLOGICAL SURVEILLANCE.— 
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treatments and prevention (such as the hepatitis C 
vaccine), and noninvasive tests that help to predict 
the risk of progression to liver cirrhosis and liver 
cancer; 
‘‘(3) conduct research that will lead to better 
noninvasive or blood tests to screen for liver cancer, 
and more effective treatments of liver cancer caused 
by chronic hepatitis B and chronic hepatitis C; and 
‘‘(4) conduct research comparing the effective-
ness of screening, diagnostic, management, and 
treatment approaches for chronic hepatitis B, chron-
ic hepatitis C, and liver cancer in the affected com-
munities. 
‘‘(e) UNDERSERVED AND DISPROPORTIONATELY AF-
FECTED POPULATIONS.—In carrying out this section, the 
Secretary shall provide expanded support for individuals 
with limited access to health education, testing, and health 
care services and groups that may be disproportionately 
affected by hepatitis B and hepatitis C. 
‘‘(f) EVALUATION
OF PROGRAM.—The Secretary 
shall develop benchmarks for evaluating the effectiveness 
of the programs and activities conducted under this sec-
tion and make determinations as to whether such bench-
marks have been achieved. 
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‘‘SEC. 399NN–2. GRANTS. 
‘‘(a) IN GENERAL.—The Secretary may award grants 
to, or enter into contracts or cooperative agreements with, 
States, political subdivisions of States, territories, Indian 
tribes, or nonprofit entities that have special expertise re-
lating to hepatitis B, hepatitis C, or both, to carry out 
activities under this part. 
‘‘(b) APPLICATION.—To be eligible for a grant, con-
tract, or cooperative agreement under subsection (a), an 
entity shall prepare and submit to the Secretary an appli-
cation at such time, in such manner, and containing such 
information as the Secretary may require. 
‘‘SEC. 399NN–3. AUTHORIZATION OF APPROPRIATIONS. 
‘‘There are authorized to be appropriated to carry out 
this part $90,000,000 for fiscal year 2015, $90,000,000 
for fiscal year 2016, $110,000,000 for fiscal year 2017, 
$130,000,000 for fiscal year 2018, and $150,000,000 for 
fiscal year 2019.’’. 
(d) ENHANCING SAMHSA’S ROLE IN HEPATITIS AC-
TIVITIES.—Paragraph (6) of section 501(d) of the Public 
Health Service Act (42 U.S.C. 290aa(d)) is amended by 
striking ‘‘HIV or tuberculosis’’ and inserting ‘‘HIV, tuber-
culosis, or hepatitis’’. 
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Subtitle C—Acquired Bone Marrow 
Failure Diseases 
SEC. 721. ACQUIRED BONE MARROW FAILURE DISEASES. 
(a) SHORT TITLE.—This subtitle may be cited as the 
‘‘Bone Marrow Failure Disease Research and Treatment 
Act of 2014’’. 
(b) FINDINGS.—The Congress finds the following: 
(1) Between 20,000 and 30,000 Americans are 
diagnosed each year with myelodysplastic syndromes, 
aplastic 
anemia, 
paroxysmal 
nocturnal 
hemo-
globinuria, and other acquired bone marrow failure 
diseases. 
(2) Acquired bone marrow failure diseases have 
a debilitating and often fatal impact on those diag-
nosed with these diseases. 
(3) While some treatments for acquired bone 
marrow failure diseases can prolong and improve the 
quality of patients’ lives, there is no single cure for 
these diseases. 
(4) The prevalence of acquired bone marrow 
failure diseases in the United States will continue to 
grow as the general public ages. 
(5) Evidence exists suggesting that acquired 
bone marrow failure diseases occur more often in 
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minority populations, particularly in Asian-American 
and Latino or Hispanic populations. 
(6) The National Heart, Lung, and Blood Insti-
tute and the National Cancer Institute have con-
ducted important research into the causes of and 
treatments for acquired bone marrow failure dis-
eases. 
(7) The National Marrow Donor Program Reg-
istry has made significant contributions to the fight 
against bone marrow failure diseases by connecting 
millions of potential marrow donors with individuals 
and families suffering from these conditions. 
(8) Despite these advances, a more comprehen-
sive Federal strategic effort among numerous Fed-
eral agencies is needed to discover a cure for ac-
quired bone marrow failure disorders. 
(9) Greater Federal surveillance of acquired 
bone marrow failure diseases is needed to gain a bet-
ter understanding of the causes of acquired bone 
marrow failure diseases. 
(10) The Federal Government should increase 
its research support for and engage with public and 
private organizations in developing a comprehensive 
approach to combat and cure acquired bone marrow 
failure diseases. 
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(c) NATIONAL ACQUIRED BONE MARROW FAILURE 
DISEASE REGISTRY.—Part B of the Public Health Service 
Act (42 U.S.C. 311 et seq.) is amended by inserting after 
section 317W, as added, the following: 
‘‘SEC. 317X. NATIONAL ACQUIRED BONE MARROW FAILURE 
DISEASE REGISTRY. 
‘‘(a) ESTABLISHMENT OF REGISTRY.— 
‘‘(1) IN GENERAL.—Not later than 6 months 
after the date of the enactment of this section, the 
Secretary, acting through the Director of the Cen-
ters for Disease Control and Prevention, shall— 
‘‘(A) develop a system to collect data on 
acquired bone marrow failure diseases; and 
‘‘(B) establish and maintain a national and 
publicly available registry, to be known as the 
National Acquired Bone Marrow Failure Dis-
ease Registry, in accordance with paragraph 
(3). 
‘‘(2) RECOMMENDATIONS
OF
ADVISORY
COM-
MITTEE.—In carrying out this subsection, the Sec-
retary shall take into consideration the recommenda-
tions of the Advisory Committee on Acquired Bone 
Marrow Failure Diseases established under sub-
section (b). 
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‘‘(3) PURPOSES OF REGISTRY.—The National 
Acquired Bone Marrow Failure Disease Registry— 
‘‘(A) shall identify the incidence and preva-
lence of acquired bone marrow failure diseases 
in the United States; 
‘‘(B) shall be used to collect and store data 
on acquired bone marrow failure diseases, in-
cluding data concerning— 
‘‘(i) the age, race or ethnicity, general 
geographic location, sex, and family history 
of individuals who are diagnosed with ac-
quired bone marrow failure diseases, and 
any other characteristics of such individ-
uals determined appropriate by the Sec-
retary; 
‘‘(ii) the genetic and environmental 
factors that may be associated with devel-
oping acquired bone marrow failure dis-
eases; 
‘‘(iii) treatment approaches for deal-
ing with acquired bone marrow failure dis-
eases; 
‘‘(iv) outcomes for individuals treated 
for acquired bone marrow failure diseases, 
including outcomes for recipients of stem 
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23:38 Aug 05, 2014
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