Breast and Cervical Cancer Mortality Prevention Act of 1990
PL 101-354 (H.R.4790), enacted 08/10/1990

PUBLIC LAW 101-354—AUG. 10, 1990 
104 STAT. 409 
Public Law 101-354 
101st Congress 
An Act 
To amend the Public Health Service Act to establish a program of grants for the 
Aug. 10, 1990 
detection and control of breast and cervical cancer. 
[H.R. 4790] 
Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled. 
Breast and 
Cervical Cancer 
SECTION 1. SHORT TITLE. 
Mortality 
Prevention Act 
This Act may be cited as the Breast and Cervical Cancer Mortal- of 1990. 
ity Prevention Act of 1990". 
42 use 201 note. 
SEC. 2. ESTABLISHMENT OF PROGRAM OF GRANTS TO STATES FOR 
PREVENTION AND CONTROL OF BREAST AND CERVICAL 
CANCER 
The Public Health Service Act (42 U.S.C. 201 et seq.) is amended 
by inserting after title XIV the following new title: 
"TITLE XV-«PREVENTIVE HEALTH MEAS-
URES WITH RESPECT TO BREAST AND 
CERVICAL CANCERS 
"SEC. 1501. ESTABLISHMENT OF PROGRAM OF GRANTS TO STATES. 
42 USC 300k. 
"(a) IN GENERAL.—The Secretary, acting through the Director of 
the Centers for Disease Control, may make grants to States on the 
basis of an established competitive review process for the purpose of 
carrying out programs— 
"(1) to screen women for breast and cervical cancer as a 
preventive health measure; 
"(2) to provide appropriate referrals for medical treatment of 
women screened pursuant to paragraph (1) and to ensure, to the 
extent practicable, the provision of appropriate follow-up 
services; 
"(3) to develop and disseminate public information and edu-
cation programs for the detection and control of breast and 
cervical cancer; 
"(4) to improve the education, training, and skills of health 
professionals (including allied health professionals) in the detec-
tion and control of breast and cervical cancer; 
"(5) to establish mechanisms through which the States can 
monitor the quality of screening procedures for breast and 
cervical cancer, including the interpretation of such procedures; 
and 
"(6) to evaluate activities conducted under paragraphs (1) 
through (5) through appropriate surveillance or program-
monitoring activities. 
"Ot)) GRANT AND CONTRACT AUTHORITY OF STATES.—A State receiv-
ing a grant under subsection (a) may expend the grant to carry out 
104 STAT. 410 
PUBLIC LAW 101-354—AUG. 10, 1990 
the purpose described in such subsection through grants to, and 
contracts with, pubUc or nonprofit private entities. 
42 use 300/. 
"SEC. 1502. REQUIREMENT OF MATCHING FUNDS. 
"(a) IN GENERAL.—The Secretary may not make a grant under 
section 1501 unless the State involved agrees, with respect to the 
costs to be incurred by the State in carrying out the purpose 
described in such section, to make available non-Federal contribu-
tions (in cash or in kind under subsection O
t
>
)
) toward such costs in 
an amount equal to not less than $1 for each $3 of Federal funds 
provided in the grant. Such contributions may be made directly or 
through donations from public or private entities. 
"(b) DETERMINATION OF AMOUNT OF NON-FEDERAL CONTRIBU-
TION.— 
"(1) IN GENERAL.—Non-Federal contributions required in 
subsection (a) may be in cash or in kind, fairly evaluated, 
including equipment or services (and excluding indirect or over-
head costs). Amounts provided by the Federal Government, or 
services assisted or subsidized to any significant extent by the 
Federal Government, may not be included in determining the 
amount of such non-Federal contributions. 
"(2) MAINTENANCE OF EFFORT.—In making a determination of 
the amount of non-Federal contributions for purposes of 
subsection (a), the Secretary may include only non-Federal 
contributions in excess of the average amount of non-Federal 
contributions made by the State involved toward the purpose 
described in section 1501 for the 2-year period preceding the 
first fiscal year for which the State is applying to receive a 
grant under such section. 
"(3) INCLUSION OF RELEVANT NON-FEDERAL CONTRIBUTIONS FOR 
MEDICAID.—In making a determination of the amount of non-
Federal contributions for purposes of subsection (a), the Sec-
retary shall, subject to paragraphs (1) and (2) of this subsection, 
include any non-Federal amounts expended pursuant to title 
XIX of the Social Security Act by the State involved toward the 
purpose described in paragraphs (1) and (2) of section 1501(a). 
42 use 300m 
"SEC. 1503. REQUIREMENTS WITH RESPECT TO TYPE AND QUALITY OF 
SERVICES. 
"(a) REQUIREMENT OF PROVISION OF ALL SERVICES BY DATE CER-
TAIN.—The Secretary may not make a grant under section 1501 
unless the State involved agrees— 
"(1) to ensure that, initially and throughout the period during 
which amounts are received pursuant to the grant, not less than 
60 percent of the grant is expended to provide each of the 
services or activities described in paragraphs (1) and (2) of 
section 1501(a), including making available screening proce-
dures for both breast and cervical cancers; 
"(2) subject to subsection (b), to ensure that— 
"(A) in the case of breast cancer, both a physical exam-
ination of the breasts and the screening procedure known 
as a mammography are conducted; and 
"(B) in the case of cervical cancer, both a pelvic examina-
tion and the screening procedure known as a pap smear are 
conducted; 
PUBLIC LAW 101-354—AUG. 10, 1990 
104 STAT. 411 
"(3) to ensure that, by the end of any second fiscal year of 
payments pursuant to the grant, each of the services or activi-
ties described in section 1501(a) is provided; and 
"(4) to ensure that not more than 40 percent of the grant is 
expended to provide the services or activities described in para-
graphs (3) through (6) of such section. 
"(b) USE OF IMPROVED SCREENING PROCEDURES.—The Secretary 
may not make a grant under section 1501 unless the State involved 
agrees that, if any screening procedure superior to a procedure 
described in subsection (aX2) becomes commonly available and is 
recommended for use, any entity providing screening procedures 
pursuant to the grant will utilize the superior procedure rather than 
the procedure described in such subsection. 
"(c) 
QUALITY ASSURANCE REGARDING SCREENING FOR BREAST 
CANCER.—The Secretary may not make a grant under section 1501 
unless the State involved agrees that the State will assure the 
quality of any screening procedure for breast cancer conducted 
pursuant to such section and, in the case of mammography, will 
provide that— 
"(1) the equipment used to perform the mammography will be 
specifically designed for mammography and will meet appro-
priate radiologic standards for mammography; 
"(2) the mammography will be performed by an individual 
who— 
"(A) is licensed by a State to perform radiological proce-
dures; or 
"(B) is certified as qualified to perform radiological proce-
dures by an appropriate orgemization; 
"(3) the results of the mammography will be interpreted by a 
physician who— 
"(A) is certified as qualified to interpret radiological 
procedures by an appropriate board; or 
"(B) is certified as qualified to interpret screening 
mammography procedures by an appropriate program for 
assuring the qualifications of the individual with respect to 
such interpretations; and 
"(4) with resj)ect to the first screening mammography per-
formed on a woman for which payment is made pursuant to 
section 1501(a), there are satisfactory assurances that the re-
sults of the mammc^aphy will be placed in permanent medical 
records maintained with respect to the woman. 
"(d) QUALITY ASSURANCE REGARDING SCREENING FOR CERVICAL 
CANCER.—The Secretary may not make a grant under section 1501 
unless the State involved agrees that the State will assure the 
quality of any screening procedure for cervical cancer conducted 
pursuant to such section and, in the case of the pap smear (or other 
cytological screening procedure replacing the pap smear pursuant to 
subsection Ob)), will provide— 
. , 
"(1) the maximum number of cytology slides that anyindivid-
ual may screen in a 24-hour period; 
"(2) requirements that a clinical laboratory maintain a record 
Records. 
. . 
'=;"• of^-
"(A) the number of cytology slides screened during each 
24-hour period by each individual who examines C3rtology 
slides for the laboratory; and 
: :. 
, 
"(B) the number of hours devoted during each 24-hour 
period to screening cytolc^y slides by such individual; 
104 STAT. 412 
PUBLIC LAW 101-354—AUG. 10, 1990 
"(3) criteria for requiring rescreening of cytological prepara-
tions, such as— 
"(A) random rescreening of cj^ology specimens deter-
mined to be in the benign category; 
"(B) focused rescreening of such preparations in high risk 
groups; and 
"(C) for each abnormal cj^ological result, rescreening of 
all prior cytological specimens for the patient, if available; 
"(4) periodic confirmation and evaluation of the proficiency of 
individuals involved in screening or interpreting cytological 
preparations, including announced and unannounced on-site 
proficiency testing of such individuals, with such testing to take 
place, to the extent practicable, under normal working 
conditions; 
"(5) procedures for detecting inadequately prepared slides, for 
assuring that no cj^ological diagnosis is rendered on such slides, 
and for notifying referring physicians of such slides; 
"(6) requirements that all cytological screening be done on the 
premises of an appropriately qualified laboratory; 
"(7) requirements for the retention of cytology slides by lab-
oratories for appropriate periods of time; and 
"(8) requirements of periodic inspection of cytology services by 
persons capable of evaluating the quality of cj^ology services. 
"(e) ISSUANCE BY SECRETARY OF GUIDELINES WITH RESPECT TO 
QUALITY OF MAMMOGRAPHY AND CYTOLOGICAL SERVICES.— 
"(1) IN GENERAL.—The Secretary shall establish guidelines for 
assuring the quality of any mammography and cytological 
screening procedure conducted pursuant to section 1501(a). Such 
guidelines with respect to mammography shall include the 
provisions of paragraphs (1) through (4) of subsection (c), and 
such guidelines with respect to cytological screening procedures 
shall include the provisions of paragraphs (1) through (8) of 
subsection (d). 
"(2) APPLICABIUTY WITH RESPECT TO GRANTS.—The Secretary 
may not make a grant under section 1501 unless the State 
involved agrees that the State will, with respect to any 
mammography or cjrtological screening procedure conducted 
pursuant to such section, ensure that the procedure is con-
ducted in accordance with the guidelines issued by the Sec-
retary under paragraph (1). 
"(3) RESPONSIBIUTY OF STATES IN ABSENCE OF GUIDEUNES.— 
With respect to circumstances in which a State receives a grant 
under section 1501 before the issuance of guidelines under 
paragraph (1), this subsection may not be construed to affect in 
such circumstances the obligation of the State pursuant to 
subsection (a)(1) to provide for screening procedures and refer-
rals or the obligations under subsections (c) and (d) with respect 
to providing for quality in the screening procedures. 
42 use 300n. 
"SEC. 1504. ADDITIONAL REQUIRED AGREEMENTS. 
"(a) PRIORITY FOR LOW-INCOME WOMEN.—The Secretary may not 
make a grant under section 1501 unless the State involved agrees 
that low-income women will be given priority in the provision of 
services and activities pursuant to paragraphs (1) and (2) of section 
1501(a). 
"(b) LIMITATION ON IMPOSITION OF FEES FOR SERVICES.—The Sec-
retary may not make a grant under section 1501 unless the State 
PUBLIC LAW 101-354—AUG. 10, 1990 
104 STAT. 413 
involved agrees that, if a charge is imposed for the provision of 
services or activities under the grant, such charge— 
"(1) will be made according to a schedule of charges that is 
made available to the public; 
"(2) will be adjusted to reflect the income of the woman 
involved; and 
"(3) will not be imposed on any woman with an income of less 
than 100 percent of the official poverty line, as established by 
the Director of the Office of Management and Budget and 
revised by the Secretary in accordance with section 673(2) of the 
Omnibus Budget Reconciliation Act of 1981. 
"(c) STATEWIDE PROVISION OF SERVICES.— 
"(1) IN GENERAL.—The Secretary may not make a grant under 
section 1501 unless the State involved agrees that services and 
activities under the grant will be made available throughout the 
State, including availability to members of any Indian tribe or 
tribal organization (as such terms are defined in section 4 of the 
Indian Self-Determination and Ekiucation Assistance Act). 
"(2) WAIVER.—The Secretary may waive the requirement 
established in paragraph (1) for a State if the Secretary deter-
mines that compliance by the State with the requirement would 
result in an inefficient allocation of resources with respect to 
carrjdng out the purpose described in section 1501(a). 
"(d) RELATIONSHIP TO ITEMS AND SERVICES UNDER OTHER PRO-
GRAMS.—The Secretary may not make a grant under section 1501 
unless the State involved agrees that the grant will not be expended 
to make payment for any item or service to the extent that payment 
has been made, or can reasonably be expected to be made, with 
respect to such item or service— 
"(1) under any State compensation program, under an insur-
ance policy, or under any Federal or State health benefits 
program; or 
"(2) by an entity that provides health services on a prepaid 
basis. 
"(e) COORDINATION WITH OTHER BREAST AND CERVICAL CANCER 
PROGRAMS.—The Secretary may not make a grant under section 
1501 unless the State involved agrees that the services and activities 
funded through the grant shall be coordinated with other Federal, 
State, and local breast and cervical cancer programs. 
"(f) LIMITATION ON ADMINISTRATIVE EXPENSES.—The Secretary 
may not make a grant under section 1501 unless the State involved 
agrees that not more than 10 percent of the grant will be expended 
for administrative expenses with respect to the grant. 
"(g) RESTRICTIONS ON USE OF GRANT.—The Secretary may not 
make a grant under section 1501 unless the State involved agrees 
that the grant will not be expended to provide inpatient hospital 
services for any individual. 
"(h) RECORDS AND AUDITS.—The Secretary may not make a grant 
under section 1501 unless the State involved agrees that— 
"(1) the State will establish such fiscal control and fund 
accounting procedures as may be necessary to ensure the proper 
disbursal of, and accounting for, amounts received by the State 
under such section; and 
"(2) upon request, the State will provide records maintained 
pursuant to paragraph (1) to the Secretary or the Comptroller of 
the United States for purposes of auditing the expenditures by 
the State of the grant. 
104 STAT. 414 
PUBLIC LAW 101-354—AUG. 10, 1990 
"(i) REPORTS TO SECRETARY.—The Secretary may not make a grant 
under section 1501 unless the State involved agrees to submit to the 
Secretary such reports as the Secretary may require with respect to 
the grant. 
42 u s e 300n-l. 
"SEC. 1505. DESCRIPTION OF INTENDED USES OF GRANT. 
"The Secretary may not make a grant under section 1501 unless— 
"(1) the State involved submits to the Secretary a description 
of the purposes for which the State intends to expend the grant; 
"(2) the description identifies the populations, areas, and 
localities in the State with a need for the services or activities 
described in section 1501(a); 
"(3) the description provides information relating to the serv-
ices and activities to be provided, including a description of the 
manner in which the services and activities will be coordinated 
with any similar services or activities of public or nonprivate 
entities; and 
"(4) the description provides assurances that the grant funds 
be used in the most cost-effective manner. 
42 u s e 300n-2. 
"SEC. 1506. REQUIREMENT OF SUBMISSION OF APPLICATION. 
"The Secretary may not make a grant under section 1501 unless 
an application for the grant is submitted to the Secretary, the 
application contains the description of intended uses required in 
section 1505, and the application is in such form, is made in such 
manner, and contains such agreements, assurances, and information 
as the Secretary determines to be necessary to carry out this title. 
42 u s e 300n-3. 
"SEC. 1507. TECHNICAL ASSISTANCE AND PROVISION OF SUPPLIES AND 
SERVICES IN LIEU OF GRANT FUNDS. 
"(a) TECHNICAL ASSISTANCE.—The Secretary may provide training 
and technical assistance with respect to the planning, development, 
and operation of any program or service carried out pursuant to 
section 1501. The Secretary may provide such technical assistance 
directly or through grants to, or contracts with, public and private 
entities. 
"(b) PROVISION OF SUPPLIES AND SERVICES IN LIEU OF GRANT 
FUNDS.— 
"(1) IN GENERAL.—Upon the request of a State receiving a 
grant under section 1501, the Secretary may, subject to para-
graph (2), provide supplies, equipment, and services for the 
purpose of aiding the State in carrying out such section and, for 
such purpose, may detail to the State any officer or employee of 
the Department of Health and Human Services. 
"(2) CORRESPONDING REDUCTION IN PAYMENTS.—With respect 
to a request described in paragraph (1), the Secretary shall 
reduce the amount of payments under the grant under section 
1501 to the State involved by an amount equal to the costs of 
detailing personnel (including pay, allowances, and travel ex-
penses) and the fair market value of any supplies, equipment, or 
services provided by the Secretary. The Secretary shall, for the 
payment of expenses incurred in complying with such request, 
expend the amounts withheld. 
PUBLIC LAW 101-354—AUG. 10, 1990 
104 STAT. 415 
"SEC. 1508. EVALUATIONS AND REPORTS. 
42 USC 300n-4. 
"(a) EVALUATIONS.—The Secretary shall, directly or through con-
tracts with public or private entities, provide for annual evaluations 
of programs carried out pursuant to section 1501. 
"(b) REPORT TO CONGRESS.—The Secretary shall, not later than 1 
year after the date on which amounts are first appropriated pursu-
ant to section 1509(a), and annually thereafter, 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 summarizing evaluations carried out pursuant to 
subsection (a) during the preceding fiscal year and making such 
recommendations for administrative and legislative initiatives with 
respect to this title as the Secretary determines to be appropriate. 
"SEC. 1509. FUNDING. 
42 USC 300n-5. 
"(a) 
AUTHORIZATION OF APPROPRIATIONS.—For the 
purpose 
of 
carrying out this title, there are authorized to be appropriated 
$50,000,000 for fiscal year 1991, and such sums as may be necessary 
for each of the fiscal years 1992 and 1993. 
"(b) SET-ASIDE FOR TECHNICAL ASSISTANCE AND PROVISION OF SUP-
PLIES AND SERVICES.—Of the amounts appropriated under subsection 
(a) for a fiscal year, the Secretary shall reserve not more than 20 
percent for carrying out section 1507.". 
Approved August 10, 1990. 
LEGISLATIVE HISTORY—H.R. 4790 (S. 2283): 
HOUSE REPORTS: No. 101-543 (Comm. on Energy and Commerce). 
SENATE REPORTS: No. 101-380 accompanying S. 2283 (Comm. on Labor and Human 
R6SOUrC6s) 
CONGRESSIONAL RECORD, Vol. 136 (1990): 
June 18, considered and passed House. 
Aug. 3, considered and p£issed Senate, amended. House concurred in Senate 
eunendment. 
39-194 O - 91 - 15 : QL 3 Part 1