Text: H.R.4790 — 101st Congress (1989-1990)All Information (Except Text)

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--H.R.4790--
H.R.4790
One Hundred First Congress of the United States of America
AT THE SECOND SESSION
Begun and held at the City of Washington on Tuesday, the twenty-third day
of January,
one thousand nine hundred and ninety
An Act
To amend the Public Health Service Act to establish a program of grants for the
detection and control of breast and cervical cancer.
 Be it enacted by the Senate and House of Representatives of the United
 States of America in Congress assembled,
SECTION 1. SHORT TITLE.
 This Act may be cited as the `Breast and Cervical Cancer Mortality Prevention
 Act of 1990'.
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 MEASURES WITH RESPECT TO BREAST AND CERVICAL
CANCERS
`SEC. 1501. ESTABLISHMENT OF PROGRAM OF GRANTS TO STATES.
 `(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 education 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 detection 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.
 `(b) GRANT AND CONTRACT AUTHORITY OF STATES- A State receiving a grant under
 subsection (a) may expend the grant to carry out the purpose described in
 such subsection through grants to, and contracts with, public or nonprofit
 private entities.
`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 contributions (in cash or in kind under subsection
 (b)) 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 CONTRIBUTION-
 `(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 overhead 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 Secretary 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).
`SEC. 1503. REQUIREMENTS WITH RESPECT TO TYPE AND QUALITY OF SERVICES.
 `(a) REQUIREMENT OF PROVISION OF ALL SERVICES BY DATE CERTAIN- 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 procedures for both breast and cervical cancers;
 `(2) subject to subsection (b), to ensure that--
 `(A) in the case of breast cancer, both a physical examination of the
 breasts and the screening procedure known as a mammography are conducted; and
 `(B) in the case of cervical cancer, both a pelvic examination and the
 screening procedure known as a pap smear are conducted;
 `(3) to ensure that, by the end of any second fiscal year of payments
 pursuant to the grant, each of the services or activities 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 paragraphs (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
 (a)(2) 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 appropriate radiologic standards
 for mammography;
 `(2) the mammography will be performed by an individual who--
 `(A) is licensed by a State to perform radiological procedures; or
 `(B) is certified as qualified to perform radiological procedures by an
 appropriate organization;
 `(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 respect to the first screening mammography performed on a woman for
 which payment is made pursuant to section 1501(a), there are satisfactory
 assurances that the results of the mammography 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 (b)), will provide--
 `(1) the maximum number of cytology slides that any individual may screen
 in a 24-hour period;
 `(2) requirements that a clinical laboratory maintain a record of--
 `(A) the number of cytology slides screened during each 24-hour period by
 each individual who examines cytology slides for the laboratory; and
 `(B) the number of hours devoted during each 24-hour period to screening
 cytology slides by such individual;
 `(3) criteria for requiring rescreening of cytological preparations, such as--
 `(A) random rescreening of cytology specimens determined to be in the
 benign category;
 `(B) focused rescreening of such preparations in high risk groups; and
 `(C) for each abnormal cytological 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 cytological 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 laboratories for
 appropriate periods of time; and
 `(8) requirements of periodic inspection of cytology services by persons
 capable of evaluating the quality of cytology 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) APPLICABILITY 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 cytological screening procedure
 conducted pursuant to such section, ensure that the procedure is conducted
 in accordance with the guidelines issued by the Secretary under paragraph (1).
 `(3) RESPONSIBILITY OF STATES IN ABSENCE OF GUIDELINES- 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
 referrals or the obligations under subsections (c) and (d) with respect to
 providing for quality in the screening procedures.
`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 Secretary may not
 make a grant under section 1501 unless the State 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 Education Assistance Act).
 `(2) WAIVER- The Secretary may waive the requirement established in paragraph
 (1) for a State if the Secretary determines that compliance by the State
 with the requirement would result in an inefficient allocation of resources
 with respect to carrying out the purpose described in section 1501(a).
 `(d) RELATIONSHIP TO ITEMS AND SERVICES UNDER OTHER PROGRAMS- 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 insurance 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.
 `(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.
`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 services 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.
`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.
`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 paragraph (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 expenses)
 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.
`SEC. 1508. EVALUATIONS AND REPORTS.
 `(a) EVALUATIONS- The Secretary shall, directly or through contracts 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 pursuant to section 1509(a),
 and annually thereafter, submit to the Committee on Energy and Commerce
 of the House of Representatives, 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.
 `(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 SUPPLIES 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.'.
Speaker of the House of Representatives.
Vice President of the United States and
President of the Senate.