An Act To Enact the Recommendations of the Task Force To Study Cervical Cancer Prevention, Detection and Education
Maine Legislature, Session 123, LD 0137
Committee: Health and Human Services
Sponsors: MARRACHE, CAMPBELL, EDMONDS, SULLIVAN, CAIN, CONOVER, CRAVEN, GROSE, MILLER, ROSEN
Amends: 22 MRSA §3174-L

Legislative Document 
No. 137 
S.P.45 
In Senate, January 9, 2007 
An Act To Enact the Recommendations of the Task Force To Study 
Cervical Cancer Prevention, Detection and Education 
Reference to the Committee on Health and Human Services suggested and ordered printed. 
Presented by Senator MARRACHE of Kennebec. 
Cosponsored by Representative CAMPBELL of Newfield and 
JOY J. O'BRIEN 
Secretary of the Senate 
Senators: President EDMONDS of Cumberland, SULLIVAN of York, Representatives: CAIN 
of Orono, CONOVER of Oakland, CRAVEN of Lewiston, GROSE of Woolwich, MILLER of 
Somerville, ROSEN of Bucksport. 
Be it enacted by the People of the State of Maine as follows: 
PART A 
Sec. A-I. 22 MRSA §3174-LL is enacted to read: 
§3174-LL. Coverage for human papiIJomavirus vaccine 
1. Coverage provided. Beginning January 1, 2008, the department shall provide 
coverage to MaineCare members for the human papillomavirus vaccine in accordance 
with the federal Department of Health and Human Services, Centers for Disease Control 
and Prevention recommended childhood and adolescent immunization schedule and 
recommended adult immunization schedule. 
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2. Rules. The department shall adopt rules to implement this section. Rules adopted 
pursuant to this subsection are routine technical rules as defined in Title 5, chapter 375, 
subchapter 2-A. 
Sec. A-2. Human papillomavirus vaccination; MaineCare reporting. The 
Department of Health and Human Services, Office of MaineCare Services shall provide 
information regarding the rate of human papillomavirus vaccination among MaineCare 
members to the Department of Health and Human Services, Maine Center for Disease 
Control and Prevention for inclusion in the initial and final evaluation reports required 
under Part D, section 3. 
Sec. A-3. State funding for the human papillomavirus vaccine. Beginning 
with state fiscal year 2007-08, the Legislature shall provide funding to the Department of 
Health and Human Services, Maine Immunization Program to support the purchase and 
distribution of the human papillomavirus vaccine and associated program operation costs. 
The Legislature shall appropriate the funds necessary to provide the human 
papillomavirus vaccine to all girls in the State 11 and 12 years of age after utilizing all 
available federal funding and federally purchased vaccine. 
Sec. A-4. Maine Immunization Program to report on program funding 
and vaccination rates. 
The Department of Health and Human Services, Maine 
Immunization Program shall report to the joint standing committee of the Legislature 
having jurisdiction over health and human services matters regarding the status of 
program funding and vaccination rates. The program shall submit an initial report to the 
committee no later than January 30, 2008 and a 2nd report no later than January 30, 2010. 
Each report must include: 
1. Program budget information for the current year and previous 2 years, including 
specific information regarding expenditures on the human papillomavirus vaccine; 
2. Documentation of any funding shortage that exists between available funds and 
the expenditures required to vaccinate 80% of Maine girls with the human papillomavirus 
vaccine and 80% of Maine children with the other vaccines on the federal Centers for 
Disease Control and Prevention recommended childhood and adolescent immunization 
schedule; and 
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3. State and national immunization rates for the human papillomavirus vaccine and 
the other vaccines on the federal Centers for Disease Control and Prevention 
recommended childhood and adolescent immunization schedule. 
PART B 
Sec. B-1. Statewide public education campaign regarding cervical cancer. 
The Department of Health and Human Services, Maine Breast and Cervical Health 
Program, referred to in this section as "the program," shall develop and implement a 
statewide public education campaign regarding cervical cancer prevention and early 
detection, including the importance of cervical cancer screening and the availability of 
the human papillomavirus vaccine. In carrying out the campaign, the program shall: 
1. 
Broadcast public service announcements, including information about cervical 
cancer prevention and early detection, for all 12 months of the year; 
2. Distribute printed information materials regarding cervical cancer to all sites that 
receive program brochures and to additional locations statewide, including, but not 
limited to, libraries, shopping malls, grocery stores, hair salons and health care facilities. 
The program must also offer these informational materials to faith-based organizations; 
3. 
Collaborate with the Department of Health and Human Services, Office of 
Minority Health to develop specific outreach initiatives for racial and ethnic minority 
populations in the State. 
Informational materials developed pursuant to subsection 2 
must be translated into languages other than English, as appropriate; and 
4. Consult with state and local organizations representing senior citizens and retired 
persons to develop specific outreach initiatives to reach women over 60 years of age. 
The program shall report its progress and results in implementing this section to the 
Department of Health and Human Services, Maine Center for Disease Control and 
Prevention for inclusion in the initial and final evaluation reports required under Part D, 
section 3. 
Sec. B-2. 
School-based cervical cancer education initiatives. 
The 
Department of Health and Human Services, Maine Center for Disease Control and 
Prevention, referred to in this section as "the center," shall coordinate the development 
and implementation of school-based cervical cancer education initiatives in accordance 
with this section. 
I. The center shall develop printed materials on cervical cancer prevention and early 
detection appropriate for students in grades 6 to 12 and college students to be posted at 
schools and universities. The center shall collaborate with the Department of Education 
and the University of Maine System to coordinate the distribution and posting of 
materials at public schools and universities. The center shall offer these materials to 
private schools and colleges. 
2. The center shall develop an educational pamphlet regarding the human 
papillomavirus vaccine for students in the 5th grade. The center shall collaborate with 
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health education staff within the Department of Education, school nurses and health 
coordinators to facilitate the distribution of the pamphlet in public schools. The center 
shaH provide copies of the pamphlet to all pediatricians and family physicians licensed in 
the State and shaH offer the pamphlet to private schools. 
3. 
The center shaH coHaborate with health education staff of the Department of 
Education to develop a listing of medical professionals willing to speak about cervical 
cancer prevention in health education classes or other appropriate forums in public 
schools on a voluntary basis. 
4. The center shaH seek grant funding to implement an activity-based cervical cancer 
education initiative in schools. 
The center shall seek input from the Department of 
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Education in developing its proposal and applying for grant funding. 
The center shaH report its progress and results in implementing this section in the 
initial and final evaluation reports required under Part D, section 3. 
Sec. B-3. Continuing medical education regarding cervical cancer. The 
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Department of Health and Human Services, Maine Center for Disease Control and 
Prevention shaH coHaborate with the Maine Medical Association's Committee on 
Continuing Medical Education and Accreditation to identify and implement strategies to 
expand continuing medical education opportunities regarding cervical cancer, including, 
but not limited to, current clinical guidelines for cervical cancer screening, human 
papillomavirus vaccines and emerging issues and technologies in cervical cancer 
prevention, detection and treatment. 
The Maine Center for Disease Control and 
Prevention shall encourage the Maine Medical Association to conduct outreach efforts to 
promote cervical cancer continuing education offerings to its members and inform them 
of the current status of the human papillomavirus vaccines, including availability, cost 
and insurance coverage. The Maine Center for Disease Control and Prevention shall 
report its progress and results in implementing this section in the initial and final 
evaluation reports required under Part D, section 3. 
PART C 
Sec. C-l. Medicaid waiver for family planning services. The Department of 
Health and Human Services, including representatives of the Office of MaineCare 
Services and the Maine Breast and Cervical Health Program, in consultation with the 
Family Planning Association of Maine, Inc., shall examine the potential costs and 
benefits of obtaining a state Medicaid family planning waiver to provide cervical cancer 
screening and related services to individuals who do not otherwise qualify for the state 
MaineCare program. The examination must include an assessment of the potential value 
of such a waiver to the State's efforts to promote cervical cancer prevention and early 
detection. 
No later than January I, 2008, the department shall make a recommendation 
to the joint standing committee of the Legislature having jurisdiction over health and 
human services matters regarding whether the State should apply to the federal 
Department of Health and Human Services, Centers for Medicare and Medicaid Services 
for a waiver. 
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Sec. C-2. 
Maine Breast and Cervical Health Program eligibility 
expansion. The Department of Health and Human Services shall amend the rules for 
the Maine Breast and Cervical Health Program to grant eligibility for cervical cancer 
screening and related services to women 35 to 39 years of age who meet all other 
eligibility criteria for the program. The program shall report its experience under this rule 
change to the Department of Health and Human Services, Maine Center for Disease 
Control and Prevention for inclusion in the initial and final evaluation reports required 
under Part D, section 3. 
Sec. C-3. 
Maine Breast and Cervical Health Program screening 
initiatives. The Department of Health and Human Services, Maine Breast and Cervical 
Health Program, referred to in this section as "the program," shall implement the 
following initiatives to increase and improve cervical cancer screening: 
1. The program shall collaborate with the Family Planning Association of Maine, Inc. 
to develop ideas for outreach and coordination to increase cervical cancer screening 
among women who are ineligible for the program, particularly women under 35 years of 
age; 
2. The program shall expand its special screening days. The expansion may include 
adding more sites, adding more screening days at current sites or a combination of these 
strategies, based on the program's assessed need and demand for services; 
3. The program shall update its clinical guidelines for cervical cancer screening based 
on a review of the most recent clinical guidelines for cervical cancer screening published 
by the American Cancer Society, the American College of Obstetricians and 
Gynecologists and the United States Preventive Services Task Force. The program shall 
offer a professional education program on clinical guidelines for cervical cancer 
screening after it has completed the update; and 
4. The program shall coordinate a stakeholder group, including representatives of the 
Department of Health and Human Services, Maine Comprehensive Cancer Control 
Program, the State Employee Health Commission, the American Cancer Society and 
health insurance carriers operating in the State, to explore options for encouraging 
insured individuals to make and attend medical appointments for cancer screening, 
including, but not limited to, cervical cancer screening. 
The program shall report its progress and results in implementing this section to the 
Department of Health and Human Services. Maine Center for Disease Control and 
Prevention for inclusion in the initial and final evaluation reports required under Part D, 
section 3. 
Sec. C-4. Maine Quality Forum review and report on health care system 
initiatives affecting the delivery of cervical cancer screening services. The 
Maine Quality Forum shall identify and assess current initiatives within the state health 
care system that may enhance the delivery of cervical cancer screening and follow-up 
medical care, including computer-based clinical improvement systems to track and 
manage patient care, provider incentives and health care quality and performance 
measures. 
The forum shall report its findings and any recommendations to the 
Department of Health and Human Services, Maine Center for Disease Control and 
Prevention for inclusion in the initial evaluation report required under Part D, section 3. 
PARTD 
Sec. D-l. Cervical cancer incidence and prevention in racial and ethnic 
minority populations. The Department of Health and Human Services, Office of 
Minority Health shall, in collaboration with the Department of Health and Human 
Services, Maine Cancer Registry, the Department of Health and Human Services, Office 
of Multicultural Affairs and the Department of Health and Human Services, Maine 
Comprehensive Cancer Control Program, examine cervical cancer incidence in racial and 
ethnic minority populations in the State and develop recommendations to improve 
cervical cancer prevention and early detection in these populations. The examination 
must include an assessment of: 
1. Available data on cervical cancer incidence among racial and ethnic minorities; 
2. 
Barriers to cervical cancer screening and treatment across different racial and 
ethnic minorities; and 
3. 
Best practices In public health education and outreach to racial and ethnic 
minorities. 
The Department of Health and Human Services, Office of Minority Health shall 
report its findings and recommendations to the Department of Health and Human 
Services, Maine Center for Disease Control and Prevention for inclusion in the initial 
evaluation report required under section 3. 
Sec. D-2. Geographic variations in cervical cancer rates. The Department 
of Health and Human Services, Maine Cancer Registry shall, in collaboration with the 
Department of Health and Human Services, Maine Breast and Cervical Health Program, 
examine geographic variation in cervical cancer rates within the State, and in particular 
the higher rates of cervical cancer observed in Washington County and Somerset County, 
and shall explore reasons for the variation. 
The Department of Health and Human 
Services, Maine Cancer Registry and the Department of Health and Human Services, 
Maine Breast and Cervical Health Program shall consult with the American Cancer 
Society, community organizations and health care providers to develop recommendations 
for reducing the incidence of cervical cancer in Washington County and Somerset 
County. The Department of Health and Human Services, Maine Cancer Registry shall 
report its findings and recommendations to the Department of Health and Human 
Services, Maine Center for Disease Control and Prevention for inclusion in the initial 
evaluation report required under section 3. 
Sec. D-3. 
Evaluation of cervical cancer prevention, detection and 
education initiatives. The Department of Health and Human Services, Maine Center 
for Disease Control and Prevention shall monitor and evaluate the State's progress in 
cervical cancer prevention, detection and education in response to the work of the 
Legislature's Task Force to Study Cervical Cancer Prevention, Detection and Education. 
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The center shall submit 2 evaluation reports to the joint standing committee of the 
Legislature having jurisdiction over health and human services matters. The reports must 
address the progress, status and outcomes of each recommendation contained in the final 
report of the task force, including, but not limited to, each initiative required under this 
Act. The initial evaluation report must be submitted no later than January 30, 2009, and 
the final evaluation report must be submitted no later than January 30, 2011. After 
review of the initial report, the joint standing committee of the Legislature having 
jurisdiction over health and human services matters may report out legislation regarding 
cervical cancer prevention, detection and education to the First Regular Session of the 
124th Legislature. After review of the final report, the joint standing committee of the 
Legislature having jurisdiction over health and human services matters may report out 
legislation regarding cervical cancer prevention, detection and education to the First 
Regular Session of the 125th Legislature. 
SUMMARY 
This bill implements the recommendations of the Task Force to Study Cervical 
Cancer Prevention, Detection and Education. 
Part A of the bill relates to the human papillomavirus vaccine. It specifically does the 
following. 
I. It requires the Department of Health and Human Services to provide coverage for 
the vaccine under the MaineCare program. 
2. It requires the Legislature to provide funding to the Department of Health and 
Human Services, Maine Immunization Program for purchasing and distributing the 
human papillomavirus vaccine to all girls 11 and 12 years of age. 
3. 
It requires the Maine Immunization Program to report to the joint standing 
committee of the Legislature having jurisdiction over health and human services matters 
on the status of program funding and vaccination rates, including specific information on 
the human papillomavirus vaccine, by January 30, 2008 and again by January 30, 20 I 0. 
Part B of the bill relates to improving public awareness and education regarding 
cervical cancer prevention. It specifically does the following. 
i. 
It requires the Department of Health and Human Services, Maine Breast and 
Cervical Health Program to develop public education materials regarding cervical cancer 
prevention and the human papillomavirus vaccine to be distributed to sites that receive 
the program's materials, as well as other locations such as I ibraries, malls and health care 
facilities. 
It requires the materials to be translated into languages other than English 
when necessary. 
2. 
It requires the Department of Health and Human Services, Maine Center for 
Disease Control and Prevention to coordinate with the Department of Education and the 
University of Maine System to develop educational materials for schools and universities. 
In addition, it requires the center to develop an educational pamphlet for 5th grade 
students and a voluntary speakers group for health education and other classes. 
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3. It requires the Maine Center for Disease Control and Prevention to collaborate 
with the Maine Medical Association to develop and expand continuing medical education 
opportunities related to cervical cancer, including appropriate screening guidelines and 
vaccination materials. 
Part C of the bill relates to expanding cervical cancer screening opportunities. It 
specifically requires the following. 
1. 
It requires the Department of Health and Human Services, including 
representatives of the Office of MaineCare Services and the Maine Breast and Cervical 
Health Program, to consult with the Family Planning Association of Maine, Inc., to 
determine the potential costs and benefits of obtaining a federal Medicaid family planning 
waiver to provide cervical cancer screening and related services to individuals that do not 
currently qualify for MaineCare. 
2. It requires the Department of Health and Human Services to expand eligibility for 
the Maine Breast and Cervical Health Program to include women 35 to 39 years of age 
who meet all other eligibility criteria for the program. 
3. It requires the Maine Breast and Cervical Health Program to coordinate with the 
Family Planning Association of Maine, Inc., to increase cervical cancer screening among 
women under 35 years of age, expand screening days to new sites or additional days, 
update screening guidelines and work with the Department of Health and Human 
Services, Maine Comprehensive Cancer Control Program, the State Employee Health 
Commission, the American Cancer Society and health insurance carriers to explore 
options for encouraging people to attend cancer screenings. 
4. 
It requires the Maine Quality Forum to identify and assess current initiatives 
within the state health care system that may enhance delivery of cervical cancer screening 
and follow-up care. 
Part D relates to future research and evaluation of cervical cancer and prevention 
efforts. It specifically does the following. 
1. It requires the Department of Health and Human Services, Office of Minority 
Health to collaborate with the Department of Health and Human Services, Maine Cancer 
Registry, the Department of Health and Human Services, Office of Multicultural Affairs 
and the Department of Health and Human Services, Maine Comprehensive Cancer 
Control Program to examine cervical cancer incidence in racial and ethnic minorities in 
the State and study barriers to screening and treatment and best practices for overcoming 
those barriers. 
2. It requires the Department of Health and Human Services, Maine Cancer Registry 
to collaborate with the Department of Health and Human Services, Maine Breast and 
Cervical Health Program to examine the higher incidence of cervical cancer in 
Washington County and Somerset County to determine reasons for the variation and 
develop recommendations for reducing cervical cancer in those counties. 
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3. 
It requires the Department of Health and Human Services, Maine Center for 
Disease Control and Prevention to monitor and evaluate state progress in implementing 
the task force's recommendations and report to the joint standing committee of the 
Legislature having jurisdiction over health and human services matters by January 30, 
2009 and again by January 30,2011. 
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