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111th Congress                                                   Report
  2d Session                  HOUSE OF REPRESENTATIVES          111-635
=======================================================================
 
 TO REAUTHORIZE AND ENHANCE JOHANNA'S LAW TO INCREASE PUBLIC AWARENESS 
           AND KNOWLEDGE WITH RESPECT TO GYNECOLOGIC CANCERS 

                                _______
                                

 September 28, 2010.--Committed to the Committee of the Whole House on 
            the State of the Union and ordered to be printed

                                _______
                                

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

                              R E P O R T

                        [To accompany H.R. 2941]

      [Including cost estimate of the Congressional Budget Office]

  The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 2941) to reauthorize and enhance Johanna's Law 
to increase public awareness and knowledge with respect to 
gynecologic 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..............................................     3
Background and Need for Legislation..............................     3
Committee Consideration..........................................     3
Committee Votes..................................................     4
Committee Oversight Findings and Recommendations.................     4
New Budget Authority, Entitlement Authority, and Tax Expenditures     4
Statement of General Performance Goals and Objectives............     4
Constitutional Authority Statement...............................     4
Earmarks and Tax and Tariff Benefit..............................     4
Federal Advisory Committee Statement.............................     4
Applicability of Law to the Legislative Branch...................     4
Federal Mandates Statement.......................................     5
Committee Cost Estimate..........................................     5
Congressional Budget Office Cost Estimate........................     5
Section-by-Section Analysis of the Legislation...................     6
Explanation of Amendment.........................................     7
Changes in Existing Law Made by the Bill, as Reported............     7

                               Amendment

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

SECTION 1. REAUTHORIZATION AND ENHANCEMENT OF JOHANNA'S LAW.

  (a) In General.--Section 317P(d) of the Public Health Service Act (42 
U.S.C. 247b-17(d)(4)) is amended--
          (1) in paragraph (4), by inserting after ``2009'' the 
        following: ``and $18,000,000 for the period of fiscal years 
        2012 through 2014''; and
          (2) by redesignating paragraph (4) as paragraph (6).
  (b) Consultation With Nonprofit Gynecologic Cancer Organizations.--
Section 317P(d) of such Act (42 U.S.C. 247b-17(d)), as amended by 
subsection (a), is further amended by inserting after paragraph (3) the 
following:
          ``(4) Consultation with nonprofit gynecologic cancer 
        organizations.--In carrying out the national campaign under 
        this subsection, the Secretary shall consult with the leading 
        nonprofit gynecologic cancer organizations, with a mission both 
        to conquer ovarian or other gynecologic cancer nationwide and 
        to provide outreach to State and local governments and 
        communities, for the purpose of determining the best practices 
        for providing gynecologic cancer information and outreach 
        services to varied populations.''.

SEC. 2. DEMONSTRATION PROJECTS REGARDING OUTREACH AND EDUCATION 
                    STRATEGIES RELATING TO GYNECOLOGIC CANCER.

  (a) In General.--Section 317P(d) of the Public Health Service Act (42 
U.S.C. 247b-17(d)), as amended by section 1, is further amended by 
inserting after paragraph (4) the following:
          ``(5) Demonstration projects regarding outreach and education 
        strategies.--
                  ``(A) In general.--The Secretary may carry out a 
                program to award grants or contracts to public or 
                nonprofit private entities for the purpose of carrying 
                out demonstration projects to test and compare 
                different evidence-based outreach and education 
                strategies to increase the awareness and knowledge of 
                women and health care providers with respect to 
                gynecologic cancers, including early warning signs, 
                risk factors, prevention, screening, and treatment 
                options. Such strategies shall include efforts directed 
                at women and their families, physicians, nurses, and 
                key health professionals.
                  ``(B) Preferences in awarding grants or contracts.--
                In making awards under subparagraph (A), the Secretary 
                shall give preference to--
                          ``(i) applicants with demonstrated expertise 
                        in gynecologic cancer education or treatment or 
                        in working with groups of women who are at 
                        increased risk of gynecologic cancers; and
                          ``(ii) applicants that, in the demonstration 
                        project funded by the grant or contract, will 
                        establish linkages between physicians, nurses, 
                        and key health professionals, health profession 
                        students, hospitals, payers, and State health 
                        departments.
                  ``(C) Application.--To seek a grant or contract under 
                subparagraph (A), an entity shall submit an application 
                to the Secretary in such form, in such manner, and 
                containing such agreements, assurances, and information 
                as the Secretary determines to be necessary to carry 
                out this paragraph.
                  ``(D) Certain requirements.--In making awards under 
                subparagraph (A), the Secretary shall--
                          ``(i) make awards, as practicable, to not 
                        fewer than five applicants; and
                          ``(ii) ensure that information provided 
                        through demonstration projects under this 
                        paragraph is consistent with the best available 
                        medical information.
                  ``(E) Report to congress.--Not later than 12 months 
                after the date of the enactment of this paragraph, and 
                annually thereafter, the Secretary shall submit to the 
                Congress a report that--
                          ``(i) summarizes the activities of 
                        demonstration projects under subparagraph (A);
                          ``(ii) evaluates the extent to which the 
                        projects were effective in increasing early 
                        detection of gynecologic cancers and awareness 
                        and knowledge of risk factors and early warning 
                        signs in the populations to which the projects 
                        were directed; and
                          ``(iii) identifies barriers to early 
                        detection and appropriate treatment of such 
                        cancers.''.
  (b) Conforming Amendment.--Section 317P(d)(3)(A) of the Public Health 
Service Act (42 U.S.C. 247b-17(d)(3)(A)) is amended by inserting 
``(other than paragraph (5))'' after ``this section''.

                          Purpose and Summary

    H.R. 2941, a bill to reauthorize Johanna's Law, was 
introduced on June 18, 2009, by Rep. Rosa DeLauro (D-CT), and 
referred to the Committee on Energy and Commerce.
    The goal of H.R. 2941 is to reauthorize and enhance 
Johanna's Law to increase public awareness and knowledge with 
respect to gynecologic cancers.

                  Background and Need for Legislation

    Gynecologic cancers--cervical, ovarian, uterine, vaginal, 
vulvar, and of the fallopian tube--are diagnosed in 77,000 
women and kill approximately 28,000 women in the United States 
every year.\1\ In December 2006, Congress passed the 
Gynecologic Cancer Education Act of 2005, or Johanna's Law, to 
direct the Department of Health and Human Services (HHS) to 
develop a national awareness campaign about the signs, 
symptoms, and risks of these cancers to educate women and 
healthcare providers.\2\ This effort is administered through 
the Centers for Disease Control and Prevention (CDC).
---------------------------------------------------------------------------
    \1\CDC, Basic Information About Gynecologic Cancers (online at 
http:www.cdc.gov/cancer/gynecologic/basic_info/).
    \2\H.R. 1245, 109th Cong. (2005).
---------------------------------------------------------------------------
    Since first receiving funds for these activities in fiscal 
year 2008, CDC has developed a campaign called Inside 
Knowledge: Get the Facts About Gynecologic Cancer, which 
includes a Web site and factsheets, supported by focus group 
research to assess the effectiveness of the efforts.\3\ 
Additional development and dissemination of materials is 
ongoing.\4\
---------------------------------------------------------------------------
    \3\CDC, Report to Congress Related to H.R. 1245, The Gynecologic 
Cancer Education and Awareness Act of 2005, or Johanna's Law (Sept. 
2008).
    \4\Committee staff email communication with CDC (July 16, 2010).
---------------------------------------------------------------------------

                        Committee Consideration

    H.R. 2941, a bill to reauthorize and enhance Johanna's Law 
to increase public awareness and knowledge with respect to 
gynecologic cancers, was introduced by Ms. DeLauro of 
Connecticut on June 18, 2009, and referred to the Committee on 
Energy and Commerce. The bill was subsequently referred to the 
Subcommittee on Health on June 19, 2009. On September 15, 2010, 
the Subcommittee held a legislative hearing on the bill. The 
Subcommittee met in open markup session to consider H.R. 2941 
on September 16, 2010. During Subcommittee consideration an 
amendment in the nature of a substitute (manager's amendment) 
by Mr. Pallone was adopted by a voice vote. Subsequently, H.R. 
2941 was favorably forwarded to the full Committee, amended, by 
a voice vote.
    On September 23, 2010, the Committee on Energy and Commerce 
met in open markup session and considered H.R. 2941 as approved 
by the Subcommittee. There were no amendments offered in full 
Committee and subsequently the Committee ordered H.R. 2941 
favorably reported to the House, as amended by the Subcommittee 
on Health, by a voice vote.

                            Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list each record vote 
on the motion to report legislation and amendments thereto. A 
motion by Mr. Waxman ordering H.R. 2941 reported to the House, 
as amended, was approved by a voice vote. There were no record 
votes taken during consideration of this bill.

            Committee Oversight Findings and Recommendations

    In compliance with clause 3(c)(1) of rule XIII and clause 
2(b)(1) of rule X of the Rules of the House of Representatives, 
the oversight findings and recommendations of the Committee are 
reflected in the descriptive portions of this report, including 
the finding that gynecological cancers kill tens of thousands 
of women in the United States each year.

   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. 2941 would result in no new budget authority, 
entitlement authority, or tax expenditures or revenues.

         Statement of General Performance Goals and Objectives

    In accordance with clause 3(c)(4) of rule XIII of the Rules 
of the House of Representatives, the performance goals and 
objectives of the Committee are reflected in the descriptive 
portions of this report, including the goal of increasing 
public awareness and knowledge with respect to gynecologic 
cancers.

                   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 H.R. 2941 is provided under 
article I, section 8, clauses 3 and 18 of the Constitution of 
the United States.

                  Earmarks and Tax and Tariff Benefits

    H.R. 2941 does not contain any congressional earmarks, 
limited tax benefits, or limited tariff benefits as defined in 
clause 9 of rule XXI of the Rules of the House of 
Representatives.

                  Federal Advisory Committee Statement

    The Committee finds that the legislation does not establish 
or authorize the establishment of an advisory committee within 
the definition of 5 U.S.C. App., section 5(b) of the Federal 
Advisory Committee Act.

             Applicability of Law to the Legislative Branch

    Section 102(b)(3) of Public Law 104-1 requires a 
description of the application of this bill to the legislative 
branch where the bill relates to terms and conditions of 
employment or access to public services and accommodations. 
H.R. 2941 contains no such provisions.

                       Federal Mandates Statement

    Section 423 of the Congressional Budget and Impoundment 
Control Act of 1974 (as amended by section 101(a)(2) of the 
Unfunded Mandates Reform Act, Public Law 104-4) requires a 
statement on whether the provisions of the report include 
unfunded mandates. In compliance with this requirement the 
Committee adopts as its own the analysis of federal mandates 
prepared by the Director of the Congressional Budget Office 
regarding H.R. 2941.

                        Committee Cost Estimate

    Pursuant to clause 3(d)(2) of rule XIII of the Rules of the 
House of Representatives, the Committee adopts as its own the 
cost estimate of H.R. 2941 prepared by the Director of the 
Congressional Budget Office pursuant to section 402 of the 
Congressional Budget Act of 1974.

               Congressional Budget Office Cost Estimate

    With respect to the requirements of clause (3)(c)(3) of 
rule XIII of the Rules of the House of Representatives and 
section 402 of the Congressional Budget Act of 1974, the 
Committee has received the following cost estimate for H.R. 
2941 from the Director of Congressional Budget Office:
                                                September 24, 2010.
Hon. Henry A. Waxman,
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. 2941, a bill to 
reauthorize and enhance Johanna's Law to increase public 
awareness and knowledge with respect to gynecologic cancers.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Lori Housman.
            Sincerely,
                                              Douglas W. Elmendorf.
    Enclosure.

H.R. 2941--A bill to reauthorize and enhance Johanna's Law to increase 
        public awareness and knowledge with respect to gynecologic 
        cancers

    Summary: H.R. 2941 would reauthorize Johanna's Law, which 
directs the Secretary of Health and Human Services to conduct a 
campaign to increase the awareness and knowledge of health care 
providers and women with respect to gynecologic cancers. The 
bill also would authorize additional activities including 
outreach to state and local governments to determine best 
practices for providing information and services, and awarding 
grants to entities to test and compare outreach and education 
strategies.
    The bill would authorize the appropriation of $18 million 
for fiscal years 2012 through 2014. Based on historical 
spending patterns for similar activities, and assuming the 
appropriation of the authorized amounts, CBO estimates that 
implementing H.R. 2941 would cost $17 million over the 2011-
2015 period. Enacting this legislation would not affect direct 
spending or revenues; therefore, pay-as-you-go procedures do 
not apply.
    H.R. 2941 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act (UMRA).
    Estimated cost to the Federal Government: The estimated 
budgetary impact of H.R. 2941 is shown in the following table. 
The costs of this legislation fall within budget function 550 
(health).

----------------------------------------------------------------------------------------------------------------
                                                               By fiscal year, in millions of dollars--
                                                     -----------------------------------------------------------
                                                                                                          2011-
                                                        2011      2012      2013      2014      2015      2015
----------------------------------------------------------------------------------------------------------------
                                  CHANGES IN SPENDING SUBJECT TO APPROPRIATIONEstimated Authorization Level.......................         0         6         6         6         0        18
Estimated Outlays...................................         0         2         5         6         4        17
----------------------------------------------------------------------------------------------------------------

    Basis of estimate: H.R. 2941 would direct the Centers for 
Disease Control and Prevention (CDC) to award grants to 
eligible entities to conduct demonstration projects to test and 
compare different outreach and education strategies to increase 
the awareness and knowledge of women and health care providers 
with respect to gynecologic cancers.
    The bill would authorize the appropriation of $18 million 
for fiscal years 2012 through 2014. For this estimate, CBO 
assumes that one-third of the authorized amount ($6 million) 
would be appropriated in each of those three years. The 
activities authorized in this act would be carried out by the 
CDC. Based on historical spending patterns for similar 
activities, CBO estimates that implementing H.R. 2941 would 
cost $17 million over the 2012-2015 period.
    Pay-as-you-go considerations: None.
    Intergovernmental or private-sector impact: H.R. 2941 
contains no intergovernmental or private-sector mandates as 
defined in UMRA and would impose no costs on state, local, or 
tribal governments.
    Estimate prepared by: Federal Costs: Lori Housman; Impact 
on State, Local, and Tribal Governments: Lisa Ramirez-Branum; 
Impact on the Private Sector: Sarah Axeen.
    Estimate approved by: Holly Harvey, Deputy Assistant 
Director for Budget Analysis.

             Section-by-Section Analysis of the Legislation


Section 1. Reauthorization and enhancement of Johanna's Law

    Section 1 reauthorizes Johanna's Law at a total level of 
$18 million for the period of FY2012 through FY2014. It also 
requires the Secretary of HHS to consult with nonprofit 
gynecologic cancer organizations in determining best practices 
for a national public awareness campaign.

Section 2. Demonstration projects regarding outreach and education 
        strategies relating to gynecologic cancer

    Section 2 permits the Secretary of HHS to make grants for 
demonstration projects to test outreach and education 
strategies to inform women and healthcare providers about 
gynecologic cancers, and to report to Congress on the 
effectiveness of the projects.

                        Explanation of Amendment

    During the Subcommittee on Health markup, Mr. Pallone of 
New Jersey offered an amendment in the nature of a substitute 
(manager's amendment), which was adopted by a voice vote. The 
substance of the substitute amendment is reflected in the 
section-by-section analysis contained in this report.

         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 III--GENERAL POWERS AND DUTIES OF PUBLIC HEALTH SERVICE

           *       *       *       *       *       *       *



Part B--Federal-State Cooperation

           *       *       *       *       *       *       *



                  HUMAN PAPILLOMAVIRUS (JOHANNA'S LAW)

  Sec. 317P. (a) * * *

           *       *       *       *       *       *       *

  (d) Johanna's Law.--
          (1) * * *

           *       *       *       *       *       *       *

          (3) Full compliance.--
                  (A) In general.--Not later than March 1, 
                2008, the Secretary shall ensure that all 
                provisions of this section (other than 
                paragraph (5)), including activities directed 
                to be carried out by the Centers for Disease 
                Control and Prevention and the Food and Drug 
                Administration, are fully implemented and being 
                complied with. Not later than April 30, 2008, 
                the Secretary shall submit to Congress a report 
                that certifies compliance with the preceding 
                sentence and that contains a description of all 
                activities undertaken to achieve such 
                compliance.

           *       *       *       *       *       *       *

          (4) Consultation with nonprofit gynecologic cancer 
        organizations.--In carrying out the national campaign 
        under this subsection, the Secretary shall consult with 
        the leading nonprofit gynecologic cancer organizations, 
        with a mission both to conquer ovarian or other 
        gynecologic cancer nationwide and to provide outreach 
        to State and local governments and communities, for the 
        purpose of determining the best practices for providing 
        gynecologic cancer information and outreach services to 
        varied populations.
          (5) Demonstration projects regarding outreach and 
        education strategies.--
                  (A) In general.--The Secretary may carry out 
                a program to award grants or contracts to 
                public or nonprofit private entities for the 
                purpose of carrying out demonstration projects 
                to test and compare different evidence-based 
                outreach and education strategies to increase 
                the awareness and knowledge of women and health 
                care providers with respect to gynecologic 
                cancers, including early warning signs, risk 
                factors, prevention, screening, and treatment 
                options. Such strategies shall include efforts 
                directed at women and their families, 
                physicians, nurses, and key health 
                professionals.
                  (B) Preferences in awarding grants or 
                contracts.--In making awards under subparagraph 
                (A), the Secretary shall give preference to--
                          (i) applicants with demonstrated 
                        expertise in gynecologic cancer 
                        education or treatment or in working 
                        with groups of women who are at 
                        increased risk of gynecologic cancers; 
                        and
                          (ii) applicants that, in the 
                        demonstration project funded by the 
                        grant or contract, will establish 
                        linkages between physicians, nurses, 
                        and key health professionals, health 
                        profession students, hospitals, payers, 
                        and State health departments.
                  (C) Application.--To seek a grant or contract 
                under subparagraph (A), an entity shall submit 
                an application to the Secretary in such form, 
                in such manner, and containing such agreements, 
                assurances, and information as the Secretary 
                determines to be necessary to carry out this 
                paragraph.
                  (D) Certain requirements.--In making awards 
                under subparagraph (A), the Secretary shall--
                          (i) make awards, as practicable, to 
                        not fewer than five applicants; and
                          (ii) ensure that information provided 
                        through demonstration projects under 
                        this paragraph is consistent with the 
                        best available medical information.
                  (E) Report to congress.--Not later than 12 
                months after the date of the enactment of this 
                paragraph, and annually thereafter, the 
                Secretary shall submit to the Congress a report 
                that--
                          (i) summarizes the activities of 
                        demonstration projects under 
                        subparagraph (A);
                          (ii) evaluates the extent to which 
                        the projects were effective in 
                        increasing early detection of 
                        gynecologic cancers and awareness and 
                        knowledge of risk factors and early 
                        warning signs in the populations to 
                        which the projects were directed; and
                          (iii) identifies barriers to early 
                        detection and appropriate treatment of 
                        such cancers.
          [(4)](6) Authorization of appropriations.--For the 
        purpose of carrying out this subsection, there is 
        authorized to be appropriated $16,500,000 for the 
        period of fiscal years 2007 through 2009 and 
        $18,000,000 for the period of fiscal years 2012 through 
        2014.

           *       *       *       *       *       *       *