[Pages S9821-S9823]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

BREAST AND CERVICAL CANCER PREVENTION AND TREATMENT ACT OF 2000

Mr. LOTT. Mr. President, I ask unanimous consent that the Senate now
proceed to the consideration of Calendar No. 641, S. 662.
The PRESIDING OFFICER. The clerk will report the bill by title.
The assistant legislative clerk read as follows:

A bill (S. 662) to amend title XIX of the Social Security
Act to provide medical assistance for certain women screened
and found to have breast or cervical cancer under a federally
funded screening program.

There being no objection, the Senate proceeded to consider the bill
which had been reported from the Committee on Finance with an amendment
to strike out all after the enacting clause and insert the part printed
in italic.

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Breast and Cervical Cancer
Prevention and Treatment Act of 2000''.

SEC. 2. OPTIONAL MEDICAID COVERAGE OF CERTAIN BREAST OR
CERVICAL CANCER PATIENTS.

(a) Coverage as Optional Categorically Needy Group.--
(1) In general.--Section 1902(a)(10)(A)(ii) of the Social
Security Act (42 U.S.C. 1396a(a)(10)(A)(ii)) is amended--
(A) in subclause (XVI), by striking ``or'' at the end;
(B) in subclause (XVII), by adding ``or'' at the end; and
(C) by adding at the end the following:

``(XVIII) who are described in subsection (aa) (relating to
certain breast or cervical cancer patients);''.

(2) Group described.--Section 1902 of the Social Security
Act (42 U.S.C. 1396a) is amended by adding at the end the
following:
``(aa) Individuals described in this subsection are
individuals who--
``(1) are not described in subsection (a)(10)(A)(i);
``(2) have not attained age 65;
``(3) have been screened for breast and cervical cancer
under the Centers for Disease Control and Prevention breast
and cervical cancer early detection program established under
title XV of the Public Health Service Act (42 U.S.C. 300k et
seq.) in accordance with the requirements of section 1504 of
that Act (42 U.S.C. 300n) and need treatment for breast or
cervical cancer; and
``(4) are not otherwise covered under creditable coverage,
as defined in section 2701(c) of the Public Health Service
Act (42 U.S.C. 300gg(c)).''.
(3) Limitation on Benefits.--Section 1902(a)(10) of the
Social Security Act (42 U.S.C. 1396a(a)(10)) is amended in
the matter following subparagraph (G)--
(A) by striking ``and (XIII)'' and inserting ``(XIII)'';
and
(B) by inserting ``, and (XIV) the medical assistance made
available to an individual described in subsection (aa) who
is eligible for medical assistance only because of
subparagraph (A)(10)(ii)(XVIII) shall be limited to medical
assistance provided during the period in which such an
individual requires treatment for breast or cervical cancer''
before the semicolon.
(4) Conforming amendments.--Section 1905(a) of the Social
Security Act (42 U.S.C. 1396d(a)) is amended in the matter
preceding paragraph (1)--
(A) in clause (xi), by striking ``or'' at the end;
(B) in clause (xii), by adding ``or'' at the end; and
(C) by inserting after clause (xii) the following:
``(xiii) individuals described in section 1902(aa),''.
(b) Presumptive Eligibility.--
(1) In general.--Title XIX of the Social Security Act (42
U.S.C. 1396 et seq.) is amended by inserting after section
1920A the following:

``presumptive eligibility for certain breast or cervical cancer
patients

``Sec. 1920B. (a) State Option.--A State plan approved
under section 1902 may provide for making medical assistance
available to an individual described in section 1902(aa)
(relating to certain breast or cervical cancer patients)
during a presumptive eligibility period.
``(b) Definitions.--For purposes of this section:
``(1) Presumptive eligibility period.--The term
`presumptive eligibility period' means, with respect to an
individual described in subsection (a), the period that--
``(A) begins with the date on which a qualified entity
determines, on the basis of preliminary information, that the
individual is described in section 1902(aa); and
``(B) ends with (and includes) the earlier of--
``(i) the day on which a determination is made with respect
to the eligibility of such individual for services under the
State plan; or
``(ii) in the case of such an individual who does not file
an application by the last day of the month following the
month during which the entity makes the determination
referred to in subparagraph (A), such last day.
``(2) Qualified entity.--
``(A) In general.--Subject to subparagraph (B), the term
`qualified entity' means any entity that--
``(i) is eligible for payments under a State plan approved
under this title; and
``(ii) is determined by the State agency to be capable of
making determinations of the type described in paragraph
(1)(A).
``(B) Regulations.--The Secretary may issue regulations
further limiting those entities that may become qualified
entities in order to prevent fraud and abuse and for other
reasons.
``(C) Rule of construction.--Nothing in this paragraph
shall be construed as preventing a State from limiting the
classes of entities that may become qualified entities,
consistent with any limitations imposed under subparagraph
(B).
``(c) Administration.--
``(1) In general.--The State agency shall provide qualified
entities with--
``(A) such forms as are necessary for an application to be
made by an individual described in subsection (a) for medical
assistance under the State plan; and
``(B) information on how to assist such individuals in
completing and filing such forms.
``(2) Notification requirements.--A qualified entity that
determines under subsection (b)(1)(A) that an individual
described in subsection (a) is presumptively eligible for
medical assistance under a State plan shall--
``(A) notify the State agency of the determination within 5
working days after the date on which determination is made;
and
``(B) inform such individual at the time the determination
is made that an application for medical assistance under the
State plan is required to be made by not later than the last
day of the month following the month during which the
determination is made.
``(3) Application for medical assistance.--In the case of
an individual described in subsection (a) who is determined
by a qualified entity to be presumptively eligible for
medical assistance under a State plan, the individual shall
apply for medical assistance under such plan by not later
than the last day of the month following the month during
which the determination is made.
``(d) Payment.--Notwithstanding any other provision of this
title, medical assistance that--
``(1) is furnished to an individual described in subsection
(a)--
``(A) during a presumptive eligibility period;
``(B) by a entity that is eligible for payments under the
State plan; and
``(2) is included in the care and services covered by the
State plan,

shall be treated as medical assistance provided by such plan
for purposes of clause (4) of the first sentence of section
1905(b).''.
(2) Conforming amendments.--
(A) Section 1902(a)(47) of the Social Security Act (42
U.S.C. 1396a(a)(47)) is amended by inserting before the
semicolon at the end the following: ``and provide for making
medical assistance available to individuals described in
subsection (a) of section 1920B during a presumptive
eligibility period in accordance with such section''.
(B) Section 1903(u)(1)(D)(v) of such Act (42 U.S.C.
1396b(u)(1)(D)(v)) is amended--
(i) by striking ``or for'' and inserting ``, for''; and
(ii) by inserting before the period the following: ``, or
for medical assistance provided to an individual described in
subsection (a) of section 1920B during a presumptive
eligibility period under such section''.
(c) Enhanced Match.--The first sentence of section 1905(b)
of the Social Security Act (42 U.S.C. 1396d(b)) is amended--
(1) by striking ``and'' before ``(3)''; and
(2) by inserting before the period at the end the
following: ``, and (4) the Federal medical assistance
percentage shall be equal to the enhanced FMAP described in
section 2105(b) with respect to medical assistance provided
to individuals who are eligible for such assistance only on
the basis of section 1902(a)(10)(A)(ii)(XVIII)''.
(d) Effective Date.--The amendments made by this section
apply to medical assistance for items and services furnished
on or after October 1, 2000, without regard to whether final
regulations to carry out such amendments have been
promulgated by such date.

Mr. LOTT. Mr. President, I ask unanimous consent that the committee
substitute be agreed to.
The PRESIDING OFFICER. Without objection, it is so ordered.
The committee amendment in the nature of a substitute was agreed to.
Mr. LOTT. Mr. President, I ask unanimous consent that the bill, as
amended, be considered read the third time.
The bill (S. 662), as amended, was considered read the third time.
Mr. LOTT. Mr. President, I further ask unanimous consent that the
Senate then proceed to Calendar No. 542, H.R. 4386, all after the
enacting clause be stricken, and the text of S. 662 be inserted in lieu
thereof. Further, I ask unanimous consent that the bill, as amended, be
read the third time and passed, the motion to reconsider be laid upon
the table, and, finally, any statements relating to this very important
piece of legislation be printed in the Record.
The PRESIDING OFFICER. Without objection, it is so ordered.
The bill (H.R. 4386), as amended, was read the third time and passed.
Mr. LOTT. I note, Mr. President, that this is the breast and cervical
cancer legislation. It has broad bipartisan support. I am very pleased
we were able to

[[Page S9822]]

come to an agreement to bring it this far. It came up this morning in
the Finance Committee. I asked the Senator from New York if he would
help us get it cleared through to this point. Senator Moynihan
indicated he would, and he has done so, as always. I do not think we
would have this clearance without his help.
Mr. MOYNIHAN. Mr. President, may I have one moment?
Mr. LOTT. Mr. President, I will be glad to yield the floor to Senator
Moynihan.
Mr. MOYNIHAN. Mr. President, we all thank the majority leader for
this action. I know it will be particularly pleasing to the chairman of
our committee, Senator Roth, who took up this measure, introduced in
the first instance by Senator Chafee. It came out of our committee
unanimously. It is good legislation. It should be pursued. We thank the
leader for his effort.
I yield the floor.
Mr. LOTT. I ask unanimous consent that S. 662 be placed back on the
calendar.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. ASHCROFT. Mr. President, I take this opportunity to commend the
Senate's passage of S. 662, the Breast and Cervical Cancer Treatment
Act. I am pleased to be a cosponsor of this important legislation,
which provides low-income, uninsured women with access to the treatment
they need to battle these two potentially devastating diseases.
In 1990, Congress created a program, administered by the Centers for
Disease Control, CDC, to provide breast and cervical cancer screening
for low-income, uninsured women. While this program's goal was to
reduce mortality rates from these two diseases, the fact many women
diagnosed under the program had no funds for treatment left our goal
largely unfulfilled.
The Breast and Cervical Cancer Treatment Act moves this Federal
commitment forward to the next logical step, by providing Medicaid
funds to treat these women who are diagnosed with breast or cervical
cancer through the CDC screening program. Under this important
legislation, American women will be able to receive the treatment they
need to win the fight against breast cancer or cervical cancer.
As we are in the waning days of this legislative session, I am glad
to join my Senate colleagues in passing the Breast and Cervical Cancer
Treatment Act, which will provide new resources and hope to low-income
women with breast or cervical cancer. As the House has already passed a
similar bill, it is my hope that Congress will present final
legislation to the President for enactment this year.
Ms. SNOWE. Mr. President, I rise today to express my unwavering
support for passage of the Breast and Cervical Cancer Treatment Act (S.
662). This bill addresses an issue that is vital to the health and
lives of so many low-income women--coverage of breast and cervical
cancer treatment under the Medicaid program.
This legislation was originally introduced by our late colleague,
Senator John Chafee of Rhode Island. Senator Chafee was always one of
the Senate's leaders on health care issues, and like all of my
colleagues, I am sad that he is not with us today to see his bill pass
the Senate. I know that he would be pleased to know that his bill now
has the support of 75 Senators.
I also want to take a moment to note the dedication of my colleagues
Senators Mikulski, Linc Chafee, Grassley, and Hatch--we have put many
hours into ensuring that today's legislation gets through the Senate
and can be reconciled quickly with the House version. Finally, this
bill would not be before us today if not for the help of the Chairman
of the Senate Finance Committee--it was Senator Roth who made a
commitment to get this bill through the Finance Committee.
In 1990, while serving in the House, I was a proud cosponsor of the
legislation that established the Center for Disease Control's National
Breast and Cervical Early Detection Program. This groundbreaking
program--sponsored in the Senate by Senator Mikulski--ensures that
women who are medically underserved in this country receive regular
screening for breast and cervical cancer. Since the program did its
very first screening in 1991, over 1.4 million women have had either a
mammogram or a test for cervical cancer. And more are screened every
single day.
It is unquestionable that early detection is our best weapon against
cancer. The success of the CDC program is proven. As a result of this
program over 6,800 uninsured, low-income women across the country now
know they have breast cancer and can take action to fight this disease.
And over 34,000 uninsured, low-income women across the country now know
they have either invasive cervical cancer or pre-cancerous cervical
lesions.
In my home state of Maine, nearly 16,000 women have gone through the
screening program since it began in 1995. And as a result of this
screening 46 women with breast cancer and 23 women with cervical cancer
have vital information that they might not have had otherwise. I don't
like to think of what could have happened if they had found out about
their cancer when it was too late.
Unfortunately, screening alone--and the life-or-death knowledge about
one's health that comes as a result--cannot save a woman's life. It is
estimated that breast and cervical cancer will kill more than half a
million women this decade alone. In fact, breast cancer is the number
one killer of American women between the ages of 35 and 54. While
screening is the first line of defense in fighting cancer, and is so
very, very important, it is really only the first part of the battle.
When the National Breast and Cervical Cancer Early Detection Program
passed in 1990, we wanted to ensure that women would receive treatment.
The law was written to require states to seek out services for the
women they screen in order to receive timely and appropriate treatment.
But the state programs are overwhelmed. Program administrators are
scrambling to find treatment services--and even then these uninsured,
low-income women must somehow come up the money for costly procedures.
This legislation will give women who have been screened through the
CDC's National Breast and Cervical Cancer Early Detection Program the
chance to receive needed treatment that is truly life-and-death. This
Act will allow states the option of providing Medicaid services to
women who have breast or cervical cancer.
I would like to explain to my colleagues why this legislation is so
important in a very personal way. One of my constituents went through
the Maine Breast and Cervical Health Program and had an abnormal
mammogram, followed by an abnormal ultrasound. She was advised to have
a sterotactic biopsy but delayed for three months because she could not
afford it. Three months in which her cancer could grow and spread. And
while she eventually had the biopsy and was not diagnosed with cancer,
these three months could have truly meant the difference between
winning or losing her battle against cancer.
The women who go through this program have undergone enough solely by
being diagnosed with cancer. And the stress of diagnosis is almost
debilitating. But to compound this stress, to leave a woman with the
knowledge that she has cancer, that she must--absolutely must-- receive
treatment or her cancer will spread, but to not help her find the means
to fight for her life is unconscionable.
We cannot sit back and claim that a screening program is enough to
save a woman's life. We know that the uninsured are 49 percent more
likely to die than are insured women during the four to seven years
following an initial breast cancer diagnosis. This is unconscionable--
we must provide an option for uninsured women who are not able to pay
for treatment on their own. We cannot sit back and watch women die from
a disease that they discovered through our program but not help them
fight this disease.
I am extremely pleased that the Senate is bringing the bill up for
passage today; the House overwhelmingly passed its version on May 9th
and I hope that the two bills will be reconciled quickly in conference.
Ms. MIKULSKI. Mr. President, I rise today in strong support of Senate
passage of the Breast and Cervical Cancer Treatment Act S. 662. I am
proud to be the lead Democratic sponsor of this

[[Page S9823]]

bill. This is legislation that will help save lives, and it has the
strong bipartisan support of 76 cosponsors. It gives states the option
of providing Medicaid coverage to low-income women diagnosed with
breast and cervical cancer through the National Breast and Cervical
Cancer Early Detection Program under the Centers for Disease Control
and Prevention, CDC.
Senate passage of this legislation was a true bipartisan team effort,
and I want to recognize the other members of this team. I want to
commend the late Senator John Chafee, who sponsored this legislation,
for his leadership and genuine commitment to the women this bill would
help. I want to thank Senators Lincoln Chafee, Moynihan, Snowe,
Grassley, and Hatch for their strong support and leadership as we have
all worked together to move this legislation through the Senate. I
thank the Majority Leader and the Democratic Leader for their
commitment to getting this bill through the Senate.
I also want to commend Senator Roth for his leadership in the Finance
Committee to ensure committee consideration and passage of this bill.
Thank you also to President Clinton and Vice President Gore who have
been supportive of providing treatment to women diagnosed with breast
and cervical cancer through the CDC screening program, especially by
including a provision similar to S. 662 in the Administration's Fiscal
Year 2001 budget.
Finally, none of us would be here today to celebrate Senate passage
of this bill without the hard work, tenacity, persistence, and
perseverance of Fran Visco and the National Breast Cancer Coalition.
They have done an outstanding job of making sure that women's voices
from across the country were heard, listened to, and well represented.
However, our work is not yet finished. The House of Representatives
must now take up and pass the bill we passed today. The House should
move swiftly to enact this legislation that has such overwhelming
bipartisan support.
The CDC screening program celebrated its 10th anniversary on August
10, 2000. The CDC screening program has provided over one million
mammograms and over one million Pap tests. Among the women screened,
over 7,000 cases of breast cancer and over 600 cases of cervical cancer
have been diagnosed. I am proud to be the Senate architect of the
legislation that created the breast and cervical cancer screening
program at the CDC, and now I'm fighting to complete the program by
adding a treatment component. There are three reasons why we must
swiftly enact the Breast and Cervical Cancer Treatment Act.
First, times have changed since the creation of the CDC screening
program ten years ago. In 1990, when I wanted to include a treatment
component in the screening program, I was told we didn't have the
money. Well, now we are running annual surpluses, instead of annual
deficits. The screening program was just a down payment, not the only
payment. We have the resources to provide treatment to these women. I
think we ought to put our money into saving lives.
Second, prevention, screening, and early detection are very
important, but alone they do not stop deaths. Screening must be
combined with treatment to reduce cancer mortality. Finally, it is only
right to provide federal resources to treat breast and cervical cancer
for those screened and diagnosed with these cancers through a federal
screening program.
I look forward to working with my colleagues on both sides of the
aisle to ensure swift enactment of the Breast and Cervical Cancer
Treatment Act in the final days of this session. Women diagnosed with
breast and cervical cancer shouldn't have to wait another year for
treatment. I can't think of any better way to mark the 10th anniversary
of the CDC screening program than by finally adding a federal treatment
component to ensure that we make a true difference in the lives of
women across this country.
Mr. ROTH. Mr. President, I am pleased that the Senate has passed
legislation that will dramatically improve the lives of lower-income
women faced with a terrifying diagnosis of breast or cervical cancer.
Ten years ago, Congress created the National Breast and Cervical
Cancer Early Detection Program, through the Centers for Disease
Control, to help lower-income women receive the early detection
services that are the best protection against breast and cervical
cancer. This important program has served more than a million women in
subsequent years. However, the screening program does not include a
treatment component. Instead, women who receive a cancer diagnosis must
rely on informal networks of donated care.
Last year, Senator John Chafee introduced S. 662, the Breast and
Cervical Cancer Treatment Act, to make it easier for women facing
breast and cervical cancer to receive necessary treatment--and I think
each and every one of us shares that important goal.
S. 662 makes treatment available through the Medicaid program. Now,
maybe some of us would have approached the problem differently. I think
there are very valid concerns about creating disease-specific
eligibility categories within the Medicaid program.
However, despite those concerns, I am pleased that the Senate passed
S. 662 because we are dealing with a thoroughly unique set of
circumstances. The new Medicaid eligibility category created in S. 662
is specifically linked to a unique and existing federal screening
program and must not, and will not, be viewed as a precedent for
extending Medicaid eligibility body-part by body-part.
Instead, today the Senate fulfills a promise made nearly 10 years
ago. We are saying to lower-income, uninsured women that we will
continue to help you access the preventive health care services you
need. But now, through S. 662, our commitment to you will not stop with
screening. If problems are found, the federal government stands ready
to work with the states to make sure you receive the treatment you need
to get well.
I am grateful to my colleagues in the Senate for joining me in
supporting this important legislation, and I look forward to working
with my colleagues in the House to quickly reconcile the differences
between our bills so we can see this necessary legislation signed into
law this year.

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