Report text available as:

(PDF provides a complete and accurate display of this text.) Tip?



110th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 1st Session                                                     110-76

======================================================================



 
      NATIONAL BREAST AND CERVICAL CANCER EARLY DETECTION PROGRAM 
                      REAUTHORIZATION ACT OF 2007

                                _______
                                

 March 27, 2007.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

 Mr. Dingell, from the Committee on Energy and Commerce, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 1132]

      [Including cost estimate of the Congressional Budget Office]

  The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 1132) to amend the Public Health Service Act to 
provide waivers relating to grants for preventive health 
measures with respect to breast and cervical cancers, having 
considered the same, report favorably thereon with an amendment 
and recommend that the bill as amended do pass.

                                CONTENTS

                                                                   Page
Amendment........................................................     2
Purpose and Summary..............................................     4
Background and Need for Legislation..............................     4
Hearings.........................................................     6
Committee Consideration..........................................     6
Committee Votes..................................................     6
Committee Oversight Findings.....................................     6
Statement of General Performance Goals and Objectives............     6
New Budget Authority, Entitlement Authority, and Tax Expenditures     6
Earmarks and Tax and Tariff Benefits.............................     6
Committee Cost Estimate..........................................     6
Congressional Budget Office Estimate.............................     7
Federal Mandates Statement.......................................     8
Advisory Committee Statement.....................................     8
Constitutional Authority Statement...............................     8
Applicability to Legislative Branch..............................     8
Section-by-Section Analysis of the Legislation...................     8
Changes in Existing Law Made by the Bill, as Reported............     9

                               Amendment

  The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``National Breast and Cervical Cancer 
Early Detection Program Reauthorization Act of 2007''.

SEC. 2. NATIONAL BREAST AND CERVICAL CANCER EARLY DETECTION PROGRAM.

  Title XV of the Public Health Service Act (42 U.S.C. 300k et seq.) is 
amended--
          (1) in section 1501(d)--
                  (A) in the heading, by striking ``2000'' and 
                inserting ``2020''; and
                  (B) by striking ``by the year 2000'' and inserting 
                ``by the year 2020'';
          (2) in section 1503, by adding at the end the following:
  ``(d) Waiver of Services Requirement on Division of Funds.--
          ``(1) In general.--The Secretary shall establish a 
        demonstration project under which the Secretary may waive the 
        requirements of paragraphs (1) and (4) of subsection (a) for 
        not more than 5 States, if--
                  ``(A) the State involved will use the waiver to 
                leverage non-Federal funds to supplement each of the 
                services or activities described in paragraphs (1) and 
                (2) of section 1501(a);
                  ``(B) the application of such requirement would 
                result in a barrier to the enrollment of qualifying 
                women;
                  ``(C) the State involved--
                          ``(i) demonstrates, to the satisfaction of 
                        the Secretary, the manner in which the State 
                        will use such waiver to expand the level of 
                        screening and follow-up services provided 
                        immediately prior to the date on which the 
                        waiver is granted; and
                          ``(ii) provides assurances, satisfactory to 
                        the Secretary, that the State will, on an 
                        annual basis, demonstrate, through such 
                        documentation as the Secretary may require, 
                        that the State has used such waiver as 
                        described in clause (i);
                  ``(D) the State involved submits to the Secretary--
                          ``(i) assurances, satisfactory to the 
                        Secretary, that the State will maintain the 
                        average annual level of State fiscal year 
                        expenditures for the services and activities 
                        described in paragraphs (1) and (2) of section 
                        1501(a) for the period for which the waiver is 
                        granted, and for the period for which any 
                        extension of such wavier is granted, at a level 
                        that is not less than--
                                  ``(I) the level of the State fiscal 
                                year expenditures for such services and 
                                activities for the fiscal year 
                                preceding the first fiscal year for 
                                which the waiver is granted; or
                                  ``(II) at the option of the State and 
                                upon approval by the Secretary, the 
                                average level of the State expenditures 
                                for such services and activities for 
                                the 3-fiscal year period preceding the 
                                first fiscal year for which the waiver 
                                is granted; and
                          ``(ii) a plan, satisfactory to the Secretary, 
                        for maintaining the level of activities carried 
                        out under the waiver after the expiration of 
                        the waiver and any extension of such waiver;
                  ``(E) the Secretary finds that granting such a waiver 
                to a State will increase the number of women in the 
                State that receive 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; and
                  ``(F) the Secretary finds that granting such a waiver 
                to a State will not adversely affect the quality of 
                each of the services or activities described in 
                paragraphs (1) and (2) of section 1501(a).
          ``(2) Duration of waiver.--
                  ``(A) In general.--In granting waivers under 
                paragraph (1), the Secretary--
                          ``(i) shall grant such waivers for a period 
                        that is not less than 1 year but not more than 
                        2 years; and
                          ``(ii) upon request of a State, may extend a 
                        waiver for an additional period that is not 
                        less than 1 year but not more than 2 years in 
                        accordance with subparagraph (B).
                  ``(B) Additional period.--The Secretary, upon the 
                request of a State that has received a waiver under 
                paragraph (1), shall, at the end of the waiver period 
                described in subparagraph (A)(i), review performance 
                under the waiver and may extend the waiver for an 
                additional period if the Secretary determines that--
                          ``(i) without an extension of the waiver, 
                        there will be a barrier to the enrollment of 
                        qualifying women;
                          ``(ii) the State requesting such extended 
                        waiver will use the waiver to leverage non-
                        Federal funds to supplement the services or 
                        activities described in paragraphs (1) and (2) 
                        of section 1501(a);
                          ``(iii) the waiver has increased, and will 
                        continue to increase, the number of women in 
                        the State that receive the services or 
                        activities described in paragraphs (1) and (2) 
                        of section 1501(a);
                          ``(iv) the waiver has not, and will not, 
                        result in lower quality in the State of the 
                        services or activities described in paragraphs 
                        (1) and (2) of section 1501(a); and
                          ``(v) the State has maintained the average 
                        annual level of State fiscal expenditures for 
                        the services and activities described in 
                        paragraphs (1) and (2) of section 1501(a) for 
                        the period for which the waiver was granted at 
                        a level that is not less than--
                                  ``(I) the level of the State fiscal 
                                year expenditures for such services and 
                                activities for the fiscal year 
                                preceding the first fiscal year for 
                                which the waiver is granted; or
                                  ``(II) at the option of the State and 
                                upon approval by the Secretary, the 
                                average level of the State expenditures 
                                for such services and activities for 
                                the 3-fiscal year period preceding the 
                                first fiscal year for which the waiver 
                                is granted.
          ``(3) Reporting requirements.--The Secretary shall include as 
        part of the evaluations and reports required under section 
        1508, the following:
                  ``(A) A description of the total amount of dollars 
                leveraged annually from Non-Federal entities in States 
                receiving a waiver under paragraph (1) and how these 
                amounts were used.
                  ``(B) With respect to States receiving a waiver under 
                paragraph (1), a description of the percentage of the 
                grant that is expended on providing each of the 
                services or activities described in--
                          ``(i) paragraphs (1) and (2) of section 
                        1501(a); and
                          ``(ii) paragraphs (3) through (6) of section 
                        1501(a).
                  ``(C) A description of the number of States receiving 
                waivers under paragraph (1) annually.
                  ``(D) With respect to States receiving a waiver under 
                paragraph (1), a description of--
                          ``(i) the number of women receiving services 
                        under paragraphs (1), (2), and (3) of section 
                        1501(a) in programs before and after the 
                        granting of such waiver; and
                          ``(ii) the average annual level of State 
                        fiscal expenditures for the services and 
                        activities described in paragraphs (1) and (2) 
                        of section 1501(a) for the year preceding the 
                        first year for which the waiver was granted.
          ``(4) Limitation.--Amounts to which a waiver applies under 
        this subsection shall not be used to increase the number of 
        salaried employees.
          ``(5) Definitions.--In this subsection:
                  ``(A) Indian tribe.--The term `Indian tribe' has the 
                meaning given the term in section 4 of the Indian 
                Health Care Improvement Act (25 U.S.C. 1603).
                  ``(B) Tribal organization.--The term `tribal 
                organization' has the meaning given the term in section 
                4 of the Indian Health Care Improvement Act.
                  ``(C) State.--The term `State' means each of the 
                several States of the United States, the District of 
                Columbia, the Commonwealth of Puerto Rico, American 
                Samoa, the Commonwealth of the Northern Mariana 
                Islands, the Republic of the Marshall Islands, the 
                Federated States of Micronesia, the Republic of Palau, 
                an Indian tribe, and a tribal organization.
          ``(6) Sunset.--The Secretary may not grant a waiver or 
        extension under this subsection after September 30, 2012.'';
          (3) in section 1508--
                  (A) in subsection (a), by striking ``evaluations of 
                the extent to which'' and all that follows through the 
                period and inserting: ``evaluations of--
          ``(1) the extent to which States carrying out such programs 
        are in compliance with section 1501(a)(2) and with section 
        1504(c); and
          ``(2) the extent to which each State receiving a grant under 
        this title is in compliance with section 1502, including 
        identification of--
                  ``(A) the amount of the non-Federal contributions by 
                the State for the preceding fiscal year, disaggregated 
                according to the source of the contributions; and
                  ``(B) the proportion of such amount of non-Federal 
                contributions relative to the amount of Federal funds 
                provided through the grant to the State for the 
                preceding fiscal year.''; and
                  (B) in subsection (b), by striking ``not later than 1 
                year after the date on which amounts are first 
                appropriated pursuant to section 1509(a), and annually 
                thereafter'' and inserting ``not later than 1 year 
                after the date of the enactment of the National Breast 
                and Cervical Cancer Early Detection Program 
                Reauthorization of 2007, and annually thereafter''; and
          (4) in section 1510(a)--
                  (A) by striking ``and'' after ``$150,000,000 for 
                fiscal year 1994,''; and
                  (B) by inserting ``, $225,000,000 for fiscal year 
                2008, $245,000,000 for fiscal year 2009, $250,000,000 
                for fiscal year 2010, $255,000,000 for fiscal year 
                2011, and $275,000,000 for fiscal year 2012'' before 
                the period at the end.

                          Purpose and Summary

    H.R. 1132, the National Breast and Cervical Cancer Early 
Detection Program Reauthorization of 2007, amends the Public 
Health Service Act to provide a five-year reauthorization of 
the National Breast and Cervical Cancer Early Detection Program 
(NBCCEDP), and in addition, to provide waivers relating to 
grants for preventive health measures concerning breast and 
cervical cancers.

                  Background and Need for Legislation

    Established by Congress in 1991, the NBCCEDP provides free 
and low-cost breast and cervical cancer screenings to low-
income, minority, or uninsured women. Following Federal 
clinical guidelines, the program targets women between the ages 
of 40 to 64 for breast cancer screening and between the ages of 
18 to 64 for cervical cancer screening. Services offered by the 
program include mammograms, clinical breast examinations, 
Papanikolaou or ``Pap'' tests, surgical consultations, and 
diagnostic testing. Administered by the Centers for Disease 
Control and Prevention (CDC), the NBCCEDP operates in all 50 
States, four U.S. territories, the District of Columbia, and 13 
American Indian and Alaska Native organizations.
    Partnering with State, local, and private entities, the 
NBCCEDP also provides education and outreach services to 
diverse populations of women. Research indicates that racial 
and ethnic minority women are less likely to have access to 
information about breast cancer or the financial resources to 
pay for important health services, including mammograms. Thus, 
the NBCCEDP makes a special effort to target racial and ethnic 
minority women for screening, outreach, and education. As a 
result, over half of all women screened by the program are 
ethnic and racial minorities.
    According to the CDC, breast cancer is the second most 
commonly diagnosed cancer in the United States. It is second 
only to lung cancer as the most common cause of death among 
women. Breast cancer mortality has steadily decreased since the 
late 1980s, a trend that experts attribute to increased 
mammography screening. It is estimated that timely mammography 
screening of all women over the age of 40 could prevent between 
13 to 15 percent of all deaths from breast cancer. When breast 
cancer is detected early, while still confined to the breast, 
the five-year survival rate is more than 95 percent. Similarly, 
cervical cancer was once the leading cause of death for women 
in the United States. Since the 1950s, however, there has been 
a 90 percent reduction in the mortality rate for cervical 
cancer. The National Cancer Institute (NCI) of the National 
Institutes of Health (NIH) has attributed this decline to 
effective Pap smear screening.
    In recognition of the clear value of breast and cervical 
cancer screenings in reducing mortality from these diseases, 
the NBCCEDP is part of a multifaceted effort to provide access 
to those women at highest risk. Since 1991, the NBCCEDP has 
served over 2.5 million women, provided over 5.8 million 
screening examinations, including more than 2.8 million 
mammograms, and diagnosed more than 22,000 breast cancers and 
1,500 cervical cancers. The NBCCEDP currently performs 
screening on more than 600,000 women annually.
    In 2000, Congress passed the Breast and Cervical Cancer 
Treatment and Prevention Act. That legislation gave States the 
option to provide Medicaid coverage for treatment of women 
diagnosed with cancer through the NBCCEDP. In 2002, Congress 
passed the Native American Breast and Cervical Cancer Treatment 
Technical Amendment Act, which added Native American women to 
the optional Medicaid eligibility category. Currently, all 50 
States plus the District of Columbia have elected this option.
    Under current law, funded programs must spend at least 60 
percent of the cooperative agreement funds awarded on 
screening, referral, and follow-up services. The remaining 40 
percent of funds awarded may be allocated toward other 
infrastructure development activities, including public 
education, professional education, quality assurance, and 
surveillance and evaluation efforts. While the emphasis on 
service provision required by the 60/40 split is appropriate 
for the vast majority of grantees, unique challenges exist in 
implementing the required 60/40 split for programs serving 
smaller populations. The cap on program activities that are not 
administrative, particularly outreach and client recruitment, 
has made it difficult to reach some eligible women, especially 
in rural States. For this reason, H.R. 1132 would allow for a 
grant 60/40 requirement waiver for no more than five States.
    This legislation would require that programs requesting a 
waiver provide to the Secretary of Health and Human Services 
justification and documentation that the number of women who 
receive preventive health and early detection services will 
increase as a result of a 60/40 requirement waiver. The 60/40 
requirement waiver will have a duration that is not less than 
one year but not more than two years. Additionally, H.R. 1132 
allows the Secretary of HHS to grant a State a waiver 
extension, upon their request, for a period that is not less 
than one year but not more than two years.
    Since the program's inception in 1991, the NBCCEDP has 
contributed to an 18 percent increase in mammography use among 
women over age 50. The Committee generally affirms the 
recommendations of the Institute of Medicine, the U.S. 
Department of Health and Human Services through its Trans-HHS 
Cancer Health Disparities Progress Review Group, and such 
patient advocacy organizations such as the American Cancer 
Society and the Susan G. Komen Breast Cancer Foundation, that 
increased funds for the NBCCEDP are justified so that more 
women may have access to these vital cancer screening services. 
As a result, the bill provides an increase in the program's 
authorized funding level for fiscal years 2008 through 2012.
    At the time of Committee consideration, this bill had 66 
cosponsors and is supported by the Susan G. Komen Breast Cancer 
Foundation and the American Cancer Society.

                                Hearings

    The Committee on Energy and Commerce has not held hearings 
on the legislation.

                        Committee Consideration

    On Tuesday, March 13, 2007, the Subcommittee on Health met 
in open markup session and approved H.R. 1132 for full 
Committee consideration, amended, by voice vote. On Thursday, 
March 15, 2007, the full Committee met in open markup session 
and ordered H.R. 1132 favorably reported to the House, amended, 
by voice vote.

                            Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list the record votes 
on the motion to report legislation and amendments thereto. 
There were no record votes taken on amendments or in connection 
with ordering H.R. 1132 reported. A motion by Mr. Dingell to 
order H.R. 1132 favorably reported to the House, amended, was 
agreed to by a voice vote.

                      Committee Oversight Findings

    Regarding clause 3(c)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee has not held oversight 
or legislative hearings on this legislation.

         Statement of General Performance Goals and Objectives

    The goals and objectives of H.R. 1132 are to update and 
reauthorize the National Breast and Cervical Cancer Early 
Detection Program, granting the program increased flexibility 
to continue to provide vital cancer screening and referral 
services.

   New Budget Authority, Entitlement Authority, and Tax Expenditures

    Regarding compliance with clause 3(c)(2) of rule XIII of 
the Rules of the House of Representatives, the Committee finds 
that H.R. 1132 would result in no new or increased budget 
authority, entitlement authority, or tax expenditures or 
revenues.

                  Earmarks and Tax and Tariff Benefits

    Regarding compliance with clause 9 of rule XXI of the Rules 
of the House of Representatives, H.R. 1132 does not contain any 
congressional earmarks, limited tax benefits, or limited tariff 
benefits as defined in clause 9(d), 9(e), or 9(f) of rule XXI.

                        Committee Cost Estimate

    The Committee adopts as its own the cost estimate prepared 
by the Director of the Congressional Budget Office pursuant to 
section 402 of the Congressional Budget Act of 1974.

                  Congressional Budget Office Estimate

    Pursuant to clause 3(c)(3) of rule XIII of the Rules of the 
House of Representatives, the following is the cost estimate 
provided by the Congressional Budget Office pursuant to section 
402 of the Congressional Budget Act of 1974:

                                     U.S. Congress,
                               Congressional Budget Office,
                                    Washington, DC, March 23, 2007.
Hon. John D. Dingell,
Chairman, Committee on Energy and Commerce,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 1132, the National 
Breast and Cervical Cancer Early Detection Program 
Reauthorization Act of 2007.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Tim 
Gronniger.
            Sincerely,
                                                   Peter R. Orszag.
    Enclosure.

H.R. 1132--National Breast and Cervical Cancer Early Detection Program 
        Reauthorization Act of 2007

    H.R. 1132 would modify the Public Health Service Act to 
authorize funding for programs to detect breast and cervical 
cancer. The bill also would set rules and conditions for grants 
to states for cervical and breast cancer detection programs, 
and would specify circumstances under which the Secretary of 
Health and Human Services could waive those rules. The bill 
would authorize the appropriation of $225 million in 2008 and 
$1.25 billion over the 2008-2012 period. ($202 million was 
appropriated for those programs for 2007.)
    Based on historical spending patterns for those activities, 
and assuming appropriation of the specified amounts, CBO 
estimates that implementing H.R. 1132 would cost $86 million in 
2008 and $1 billion over the 2008-2012 period. Enacting H.R. 
1132 would not affect direct spending or receipts.
    H.R. 1132 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act, and in 
some cases it would ease the conditions of grants that states 
receive for programs to detect breast and cervical cancer.
    The estimated budgetary impact of H.R. 1132 is shown in the 
following table. The costs of this legislation fall within 
budget function 550 (health).


----------------------------------------------------------------------------------------------------------------
                                                                  By fiscal year, in millions of dollars--
                                                           -----------------------------------------------------
                                                              2007     2008     2009     2010     2011     2012
----------------------------------------------------------------------------------------------------------------
                                        SPENDING SUBJECT TO APPROPRIATION

Spending Under Current Law:
    Budget Authority \1\..................................      202        0        0        0        0        0
    Estimated Outlays.....................................      198      122       35        9        1        0
Proposed Changes:
    Authorization Level...................................        0      225      245      250      255      275
    Estimated Outlays.....................................        0       86      191      230      245      258
Spending Under H.R. 1132:
    Authorization Level \1\...............................      202      225      245      250      255      275
    Estimated Outlays.....................................      198      208      226      239      246     258
----------------------------------------------------------------------------------------------------------------
\1\ The 2007 level is the amount appropriated for that year for programs to detect breast and cervical cancer.

    The CBO staff contact for this estimate is Tim Gronniger. 
Public- and private-sector mandate statements were prepared by 
Leo Lex and Peter Richmond, respectively. This estimate was 
approved by Peter H. Fontaine, Deputy Assistant Director for 
Budget Analysis.

                       Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates prepared by the Director of the Congressional Budget 
Office pursuant to section 423 of the Unfunded Mandates Reform 
Act.

                      Advisory Committee Statement

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act were created by this 
legislation.

                   Constitutional Authority Statement

    Pursuant to clause 3(d)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee finds that the 
Constitutional authority for this legislation is provided in 
the provisions of Article I, section 8, clause 1 that relate to 
expending funds to provide for the general welfare of the 
United States.

                  Applicability to Legislative Branch

    The Committee finds that the legislation does not relate to 
the terms and conditions of employment or access to public 
services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

             Section-by-Section Analysis of the Legislation


Section 1. Short title

    Section 1 establishes the short title as the ``National 
Breast and Cervical Cancer Early Detection Program 
Reauthorization Act of 2007.''

Section 2. National Breast and Cervical Cancer Early Detection Program

    Section 2 amends title XV of the Public Health Service Act 
(42 U.S.C. 300k et seq.) by updating the current law respecting 
the existing coordinating committee regarding year 2000 health 
objectives from 2000 health objectives to year 2020 health 
objectives.
    Section 2 provides that the Secretary of Health and Human 
Services may waive the 60/40 funding requirement for no more 
than five States if the following conditions apply: (1) the 
State will use the waiver to leverage non-Federal funds; (2) 
keeping the 60/40 requirement in place will result in a barrier 
to women seeking services; (3) the Secretary determines that 
granting such a waiver will increase the number of women in the 
State that receive screening services; (4) the State will 
maintain the average annual level of State fiscal year 
expenditures for screening services for the period for which 
the waiver is granted at a level not less than the level of the 
State fiscal year expenditures for such services and activities 
for the fiscal year preceding the first fiscal year for which 
the waiver is granted or at the option of the State, and upon 
approval by the Secretary, the average level of the State 
expenditures for such services for the 3-fiscal-year period 
preceding the first fiscal year for which the waiver is 
granted; and (5) granting the waiver will not adversely affect 
the quality of services available.
    Section 2 provides that waivers will last for a period that 
is not less than one year but not more than two years. The 
Secretary may grant a renewal of a waiver for an additional 
period, of not less than one year but not more than two years, 
if the following applies: (1) without a waiver extension, a 
barrier to eligible women will result; (2) the State will use 
the waiver to leverage non-Federal funds; (3) the waiver has 
increased, and will continue to increase, the number of women 
receiving services; (4) the waiver has not adversely affected 
the quality of services available; and (5) the State has 
maintained the average annual level of fiscal expenditures for 
the screening services for the fiscal year preceding the first 
fiscal year for which the waiver was granted or, with approval 
by the Secretary, the average level of the State expenditures 
for the 3-fiscal-year period preceding the first fiscal year 
for which the waiver was granted.
    Section 2 also includes reporting requirements to ensure 
that the waivers are achieving their intended results. To this 
end, HHS will include the following in its required reports: 
(1) a description of the total amount of dollars leveraged 
annually from non-Federal entities in States that receive a 
waiver; (2) for States that receive waivers, the percentage of 
the grant that is spent on each service must be specified; (3) 
States receiving waivers must be specified; and (4) States that 
receive waivers must include a description of the number of 
women receiving services as well as the average annual level of 
State fiscal expenditures for these services for the year 
preceding the first year for which the waiver was granted. 
Furthermore, Section 2 includes a limitation requiring that a 
waiver shall not be used to increase the number of salaried 
employees.
    Section 2 also includes a sunset whereby the Secretary may 
not grant a waiver or extension after September 30, 2012.
    Section 2 authorizes appropriations of $225,000,000 for 
fiscal year 2008; $245,000,000 for fiscal year 2009; 
$250,000,000 for fiscal year 2010; $255,000,000 for fiscal year 
2011; and $275,000,000 for fiscal year 2012.

         Changes in Existing Law Made by the Bill, as Reported

    In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italic, existing law in which no change is 
proposed is shown in roman):

                       PUBLIC HEALTH SERVICE ACT



           *       *       *       *       *       *       *
    TITLE XV--PREVENTIVE HEALTH MEASURES WITH RESPECT TO BREAST AND 
                            CERVICAL CANCERS

SEC. 1501. ESTABLISHMENT OF PROGRAM OF GRANTS TO STATES.

  (a) * * *

           *       *       *       *       *       *       *

  (d) Coordinating Committee Regarding Year [2000] 2020 Health 
Objectives.--The Secretary, acting through the Director of the 
Centers for Disease Control and Prevention, shall establish a 
committee to coordinate the activities of the agencies of the 
Public Health Service (and other appropriate Federal agencies) 
that are carried out toward achieving the objectives 
established by the Secretary for reductions in the rate of 
mortality from breast and cervical cancer in the United States 
by the year [2000] 2020. Such committee shall be comprised of 
Federal officers or employees designated by the heads of the 
agencies involved to serve on the committee as representatives 
of the agencies, and such representatives from other public or 
private entities as the Secretary determines to be appropriate.

           *       *       *       *       *       *       *


SEC. 1503. REQUIREMENTS WITH RESPECT TO TYPE AND QUALITY OF SERVICES.

  (a) * * *

           *       *       *       *       *       *       *

  (d) Waiver of Services Requirement on Division of Funds.--
          (1) In general.--The Secretary shall establish a 
        demonstration project under which the Secretary may 
        waive the requirements of paragraphs (1) and (4) of 
        subsection (a) for not more than 5 States, if--
                  (A) the State involved will use the waiver to 
                leverage non-Federal funds to supplement each 
                of the services or activities described in 
                paragraphs (1) and (2) of section 1501(a);
                  (B) the application of such requirement would 
                result in a barrier to the enrollment of 
                qualifying women;
                  (C) the State involved--
                          (i) demonstrates, to the satisfaction 
                        of the Secretary, the manner in which 
                        the State will use such waiver to 
                        expand the level of screening and 
                        follow-up services provided immediately 
                        prior to the date on which the waiver 
                        is granted; and
                          (ii) provides assurances, 
                        satisfactory to the Secretary, that the 
                        State will, on an annual basis, 
                        demonstrate, through such documentation 
                        as the Secretary may require, that the 
                        State has used such waiver as described 
                        in clause (i);
                  (D) the State involved submits to the 
                Secretary--
                          (i) assurances, satisfactory to the 
                        Secretary, that the State will maintain 
                        the average annual level of State 
                        fiscal year expenditures for the 
                        services and activities described in 
                        paragraphs (1) and (2) of section 
                        1501(a) for the period for which the 
                        waiver is granted, and for the period 
                        for which any extension of such wavier 
                        is granted, at a level that is not less 
                        than--
                                  (I) the level of the State 
                                fiscal year expenditures for 
                                such services and activities 
                                for the fiscal year preceding 
                                the first fiscal year for which 
                                the waiver is granted; or
                                  (II) at the option of the 
                                State and upon approval by the 
                                Secretary, the average level of 
                                the State expenditures for such 
                                services and activities for the 
                                3-fiscal year period preceding 
                                the first fiscal year for which 
                                the waiver is granted; and
                          (ii) a plan, satisfactory to the 
                        Secretary, for maintaining the level of 
                        activities carried out under the waiver 
                        after the expiration of the waiver and 
                        any extension of such waiver;
                  (E) the Secretary finds that granting such a 
                waiver to a State will increase the number of 
                women in the State that receive 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; and
                  (F) the Secretary finds that granting such a 
                waiver to a State will not adversely affect the 
                quality of each of the services or activities 
                described in paragraphs (1) and (2) of section 
                1501(a).
          (2) Duration of waiver.--
                  (A) In general.--In granting waivers under 
                paragraph (1), the Secretary--
                          (i) shall grant such waivers for a 
                        period that is not less than 1 year but 
                        not more than 2 years; and
                          (ii) upon request of a State, may 
                        extend a waiver for an additional 
                        period that is not less than 1 year but 
                        not more than 2 years in accordance 
                        with subparagraph (B).
                  (B) Additional period.--The Secretary, upon 
                the request of a State that has received a 
                waiver under paragraph (1), shall, at the end 
                of the waiver period described in subparagraph 
                (A)(i), review performance under the waiver and 
                may extend the waiver for an additional period 
                if the Secretary determines that--
                          (i) without an extension of the 
                        waiver, there will be a barrier to the 
                        enrollment of qualifying women;
                          (ii) the State requesting such 
                        extended waiver will use the waiver to 
                        leverage non-Federal funds to 
                        supplement the services or activities 
                        described in paragraphs (1) and (2) of 
                        section 1501(a);
                          (iii) the waiver has increased, and 
                        will continue to increase, the number 
                        of women in the State that receive the 
                        services or activities described in 
                        paragraphs (1) and (2) of section 
                        1501(a);
                          (iv) the waiver has not, and will 
                        not, result in lower quality in the 
                        State of the services or activities 
                        described in paragraphs (1) and (2) of 
                        section 1501(a); and
                          (v) the State has maintained the 
                        average annual level of State fiscal 
                        expenditures for the services and 
                        activities described in paragraphs (1) 
                        and (2) of section 1501(a) for the 
                        period for which the waiver was granted 
                        at a level that is not less than--
                                  (I) the level of the State 
                                fiscal year expenditures for 
                                such services and activities 
                                for the fiscal year preceding 
                                the first fiscal year for which 
                                the waiver is granted; or
                                  (II) at the option of the 
                                State and upon approval by the 
                                Secretary, the average level of 
                                the State expenditures for such 
                                services and activities for the 
                                3-fiscal year period preceding 
                                the first fiscal year for which 
                                the waiver is granted.
          (3) Reporting requirements.--The Secretary shall 
        include as part of the evaluations and reports required 
        under section 1508, the following:
                  (A) A description of the total amount of 
                dollars leveraged annually from Non-Federal 
                entities in States receiving a waiver under 
                paragraph (1) and how these amounts were used.
                  (B) With respect to States receiving a waiver 
                under paragraph (1), a description of the 
                percentage of the grant that is expended on 
                providing each of the services or activities 
                described in--
                          (i) paragraphs (1) and (2) of section 
                        1501(a); and
                          (ii) paragraphs (3) through (6) of 
                        section 1501(a).
                  (C) A description of the number of States 
                receiving waivers under paragraph (1) annually.
                  (D) With respect to States receiving a waiver 
                under paragraph (1), a description of--
                          (i) the number of women receiving 
                        services under paragraphs (1), (2), and 
                        (3) of section 1501(a) in programs 
                        before and after the granting of such 
                        waiver; and
                          (ii) the average annual level of 
                        State fiscal expenditures for the 
                        services and activities described in 
                        paragraphs (1) and (2) of section 
                        1501(a) for the year preceding the 
                        first year for which the waiver was 
                        granted.
          (4) Limitation.--Amounts to which a waiver applies 
        under this subsection shall not be used to increase the 
        number of salaried employees.
          (5) Definitions.--In this subsection:
                  (A) Indian tribe.--The term ``Indian tribe'' 
                has the meaning given the term in section 4 of 
                the Indian Health Care Improvement Act (25 
                U.S.C. 1603).
                  (B) Tribal organization.--The term ``tribal 
                organization'' has the meaning given the term 
                in section 4 of the Indian Health Care 
                Improvement Act.
                  (C) State.--The term ``State'' means each of 
                the several States of the United States, the 
                District of Columbia, the Commonwealth of 
                Puerto Rico, American Samoa, the Commonwealth 
                of the Northern Mariana Islands, the Republic 
                of the Marshall Islands, the Federated States 
                of Micronesia, the Republic of Palau, an Indian 
                tribe, and a tribal organization.
          (6) Sunset.--The Secretary may not grant a waiver or 
        extension under this subsection after September 30, 
        2012.

           *       *       *       *       *       *       *


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. 
Such evaluations shall include [evaluations of the extent to 
which States carrying out such programs are in compliance with 
section 1501(a)(2) and with section 1504(c).] evaluations of--
          (1) the extent to which States carrying out such 
        programs are in compliance with section 1501(a)(2) and 
        with section 1504(c); and
          (2) the extent to which each State receiving a grant 
        under this title is in compliance with section 1502, 
        including identification of--
                  (A) the amount of the non-Federal 
                contributions by the State for the preceding 
                fiscal year, disaggregated according to the 
                source of the contributions; and
                  (B) the proportion of such amount of non-
                Federal contributions relative to the amount of 
                Federal funds provided through the grant to the 
                State for the preceding fiscal year.
  (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] not later 
than 1 year after the date of the enactment of the National 
Breast and Cervical Cancer Early Detection Program 
Reauthorization of 2007, 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, including 
recommendations regarding compliance by the States with section 
1501(a)(2) and with section 1504(c).

           *       *       *       *       *       *       *


SEC. 1510. FUNDING FOR GENERAL PROGRAM.

  (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, such sums as may 
be necessary for each of the fiscal years 1992 and 1993, 
$150,000,000 for fiscal year 1994, [and] such sums as may be 
necessary for each of the fiscal years 1995 through 2003, 
$225,000,000 for fiscal year 2008, $245,000,000 for fiscal year 
2009, $250,000,000 for fiscal year 2010, $255,000,000 for 
fiscal year 2011, and $275,000,000 for fiscal year 2012.

           *       *       *       *       *       *       *