Text: S.2283 — 101st Congress (1989-1990)All Information (Except Text)

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Calendar No. 703
101st CONGRESS
2d Session
S. 2283
[Report No. 101-380]
A BILL
To amend the Public Health Service Act to establish a program of grants for the
prevention and control of breast and cervical cancer, and for other purposes.
July 19 (legislative day, JULY 10), 1990
Reported with an amendment
S 2283 RS
Calendar No. 703
101st CONGRESS
2d Session
S. 2283
[Report No. 101-380]
IN THE SENATE OF THE UNITED STATES
March 9 (legislative day, JANUARY 23), 1990
Ms. MIKULSKI (for herself, Mrs. KASSEBAUM, Mr. KENNEDY, Mr. DURENBERGER,
Mr. HOLLINGS, Mr. DODD, Mr. PELL, Mr. JEFFORDS, Mr. BRADLEY, Mr. HATFIELD,
Mr. NUNN, Mr. MOYNIHAN, Mr. ADAMS, Mr. GRAHAM, Mr. LIEBERMAN, Mr. INOUYE,
Mr. SIMPSON, Mr. RIEGLE, Mr. HEINZ, Mr. COHEN, Mr. CHAFEE, Mr. WILSON,
Mr. METZENBAUM, Mr. MITCHELL, Mr. SIMON, Mr. REID, Mr. BUMPERS, Mr. LEAHY,
Mr. STEVENS, Mr. BINGAMAN, Mr. KOHL, Mr. KERRY, Mr. SARBANES, Mr. BURDICK,
Mr. ROCKEFELLER, Mr. LEVIN, Mr. GORE, Mr. SPECTER, Mr. GLENN, and Mr. CRANSTON)
introduced the following bill; which was read twice and referred to the
Committee on Labor and Human Resources
July 19 (legislative day, JULY 10), 1990
Reported by Mr. KENNEDY, with an amendment
[Strike out all after the enacting clause and insert the part printed
in italic]
A BILL
To amend the Public Health Service Act to establish a program of grants for the
prevention and control of breast and cervical cancer, and for other purposes.
  Be it enacted by the Senate and House of Representatives of the United
  States of America in Congress assembled,
 [Struck out->] 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 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 provide appropriate
 follow-up services with respect to the effect of such referrals; []   `(3) to develop and disseminate public information and
 education programs for the prevention and control of breast and cervical
 cancer; []   `(4) to improve the education, training, and skills
 of health professionals (including allied health professionals) in the
 prevention and control of breast and cervical cancer; []   `(5) to establish mechanisms through which the State 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) PREFERENCES IN MAKING GRANTS- In making grants under
 subsection (a), the Secretary shall give preference to any State in which--
 []   `(1) there is a substantial rate of mortality associated with
 breast or cervical cancer (relative to the national rate of such mortality);
 and []   `(2) there is an inadequate availability of services or
 activities described in such subsection. []   `(c) GEOGRAPHIC DISTRIBUTION OF GRANTS- In making grants
 under subsection (a), the Secretary shall ensure that the grants are
 equitably distributed among the principal geographic regions of the United
 States. []   `(d) 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, the screening procedure
 known as a pap smear is 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, 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) 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. []   `(f) 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. []   `(g) 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); and []   `(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. [] `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),
 the Secretary shall reserve not less than 20 percent for carrying out
 section 1507. []   `(c) LIMITATION ON NUMBER OF INITIAL GRANTS- For fiscal
 year 1991, the Secretary may not make more than 7 grants under section
 1501.'. [