[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2202 Engrossed Amendment Senate (EAS)]

103d CONGRESS

  1st Session

                               H. R. 2202

_______________________________________________________________________

                               AMENDMENT
                  In the Senate of the United States,

                                                      November 2, 1993.
      Resolved, That the bill from the House of Representatives (H.R. 
2202) entitled ``An Act to amend the Public Health Service Act to 
revise and extend the program of grants relating to preventive health 
measures with respect to breast and cervical cancer'', do pass with the 
following

                               AMENDMENT:

            Strike out all after the enacting clause and insert:

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Early Detection and Preventive 
Health Act of 1993''.

                         TITLE I--TUBERCULOSIS

SEC. 101. SHORT TITLE.

    This title may be cited as the ``Tuberculosis Prevention and 
Control Amendments of 1993''.

SEC. 102. FINDINGS.

    Congress finds that--
            (1) between 10,000,000 and 15,000,000 people in the United 
        States have been infected with tuberculosis, nearly 26,000 new 
        active cases are reported each year, and over 1,700 
        tuberculosis-related deaths occur each year;
            (2) the number of reported cases of tuberculosis has risen 
        from 22,201 in 1985 to 26,673 in 1992, representing 51,000 more 
        cases than those that would have been expected since 1985;
            (3) a recent national survey discovered that 14.4 percent 
        of all active tuberculosis cases were resistant to at least one 
        drug;
            (4) drug resistant tuberculosis strains can cost more than 
        $150,000 to treat, and even then, between 40 and 60 percent of 
        the patients receiving such treatment die;
            (5) in 1992, tuberculosis cases were reported to the 
        Centers for Disease Control and Prevention by all 50 States, 
        and cases resistant to one or more tuberculosis drugs were 
        reported in at least 36 States, the District of Columbia and 
        Puerto Rico;
            (6) in 1992, 27 percent of the reported cases of 
        tuberculosis occurred in foreign born persons;
            (7) one third of the world's population harbors 
        tuberculosis; and
            (8) among infectious diseases tuberculosis is still the 
        number one killer in the world with an estimated 8,000,000 new 
        cases each year and 2,900,000 deaths.

SEC. 103. PROGRAMS OF CENTERS FOR DISEASE CONTROL AND PREVENTION.

    (a) Provision of Services for Prevention, Control, and 
Elimination.--Section 317(j)(2) of the Public Health Service Act (42 
U.S.C. 247b(j)(2)) is amended--
            (1) by inserting ``(A)'' after the paragraph designation;
            (2) in the first sentence by striking ``and'' after 
        ``1991,'' and all that follows through ``1995'' and inserting 
        the following: ``, $200,000,000 for fiscal year 1994, and such 
        sums as may be necessary for each of the fiscal years 1995 
        through 1997, of which not more than $50,000,000 may be made 
        available in each such fiscal year for grants under 
        subparagraph (B)''; and
            (3) by adding at the end thereof the following new 
        subparagraph:
    ``(B) With respect to amounts made available to carry out this 
subparagraph, the Secretary, acting through the Director of the Centers 
for Disease Control and Prevention, may use such amounts to make 
emergency grants for the prevention, control, and elimination of 
tuberculosis. The Secretary may make such a grant only if the 
geographic area in which activities under the grant are to be carried 
out has, relative to other areas, a substantial incidence of cases of 
tuberculosis or a substantial rate of increase in such cases.''.
    (b) State Tuberculosis Plan.--Section 317(j) of the Public Health 
Service Act (42 U.S.C. 247b(j)) is amended by adding at the end thereof 
the following new paragraph:
    ``(3)(A) With respect to an application submitted by a State for a 
grant under this section for the prevention, control and elimination of 
tuberculosis, such application shall contain a State plan that 
demonstrates that amounts received under the grant will be expended in 
a manner that ensures that tuberculosis services will be provided to 
those at the highest risk of contracting tuberculosis, or in those 
areas with the highest rates of tuberculosis infection.
    ``(B) Such plans shall demonstrate that the applicant will work 
closely with and provide support to entities receiving funds under 
sections 329, 330, 340, 340A, or titles V or XIX, and to correctional 
facilities, and nongovernmental organizations such as community-based 
organizations and describe how the State intends to carry out the 
requirements of section 1924(a).
    ``(C) Such plans shall demonstrate that grant funds will be used 
for directly observed therapy or other effective interventions with 
respect to populations with the highest rates of active infection with 
tuberculosis.
    ``(D) In developing the State plan, each State shall ensure that 
the entities described in subparagraph (B), the single State agency for 
drug and alcohol services and any other State agency that has 
responsibility for individuals in need of tuberculosis services are 
consulted during the planning process.''.
    (c) Research, Demonstration Projects, Education, and Training.--
            (1) In general.--Section 317(k)(2) of the Public Health 
        Service Act (42 U.S.C. 247b(k)(2)) is amended--
                    (A) by redesignating subparagraphs (A) through (D) 
                as clauses (i) through (iv), respectively;
                    (B) by inserting ``(A)'' after the paragraph 
                designation; and
                    (C) by adding at the end thereof the following new 
                subparagraphs:
    ``(B) In support of grants referred to in subparagraph (A), the 
Secretary may conduct or support applied research and training 
regarding the surveillance, diagnostic methodologies, prevention, 
control, and treatment of tuberculosis, including intramural projects 
and extramural projects.
    ``(C) For the purpose of carrying out subparagraphs (A) and (B), 
there are authorized to be appropriated $26,000,000 for fiscal year 
1994, and such sums as may be necessary for each of the fiscal years 
1995 through 1997. The authorization of appropriations established in 
the preceding sentence is in addition to the authorization of 
appropriations established in subsection (j)(2) for carrying out this 
paragraph.''.
            (2) Technical amendment.--Section 317(j)(2) of the Public 
        Health Service Act (42 U.S.C. 247b(j)(2)) is amended by 
        striking the last sentence.

SEC. 104. RESEARCH THROUGH NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS 
              DISEASES.

    (a) Certain Duties.--
            (1) In general.--Subpart 6 of part C of title IV of the 
        Public Health Service Act (42 U.S.C. 285f) is amended by 
        inserting after section 446 the following section:

        ``research and research training regarding tuberculosis

    ``Sec. 447. In carrying out section 446, the Director of the 
Institute shall conduct or support basic research and research training 
regarding the cause, diagnosis, early detection, prevention and 
treatment of tuberculosis.''.
            (2) Conforming amendment.--Section 446 of the Public Health 
        Service Act (42 U.S.C. 285f) is amended by inserting after 
        ``Diseases'' the following: ``(hereafter in this subpart 
        referred to as the `Institute')''.
    (b) Authorization of Appropriations.--Section 408(a) of the Public 
Health Service Act (42 U.S.C. 284c(a)) is amended by adding at the end 
the following new paragraph:
            ``(3) For the purpose of carrying out section 447 (relating 
        to research on tuberculosis through the National Institute on 
        Allergy and Infectious Diseases), there are authorized to be 
        appropriated $46,000,000 for fiscal year 1994, and such sums as 
        may be necessary for each of the fiscal years 1995 through 
        1997. The authorization of appropriations established in the 
        preceding sentence may not be construed as terminating the 
        availability for such purpose of any other authorization of 
        appropriations.''.

SEC. 105. RESEARCH THROUGH THE FOOD AND DRUG ADMINISTRATION.

    Chapter V of the Food, Drug and Cosmetic Act is amended by 
inserting after section 512 (21 U.S.C. 360b) the following new section:

``SEC. 512A. TUBERCULOSIS DRUG AND DEVICE RESEARCH.

    ``(a) Authority.--The Commissioner of Food and Drugs shall 
implement a tuberculosis drug and device research program under which 
the Commissioner shall--
            ``(1) provide assistance to other Federal agencies for the 
        development of tuberculosis protocols;
            ``(2) review and evaluate medical devices designed for the 
        diagnosis and control of airborne tuberculosis; and
            ``(3) conduct research concerning drugs or devices to be 
        used in diagnosing, controlling and preventing tuberculosis.
    ``(b) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section, $5,000,000 for each of the 
fiscal years 1994 through 1997.''.

SEC. 106. CONVERSION OR RENOVATION OF PUBLIC HEALTH FACILITIES.

    Section 1610 of the Public Health Service Act (42 U.S.C. 300r) is 
amended by adding at the end the following subsection:
    ``(c)(1) With respect to services for the prevention, control, and 
elimination of tuberculosis, the Secretary may make grants to public 
and nonprofit private entities for--
            ``(A) conversion of existing facilities into outpatient 
        medical facilities or facilities for long-term care to provide 
        such services for such populations;
            ``(B) renovation of inpatient facilities; or
            ``(C) renovation of facilities to provide such services 
        with respect to incarceration.
    ``(2) The amount of any grant under paragraph (1) may not exceed 50 
percent of the cost of the project for which the grant is made unless 
the project is located in an area determined by the Secretary to be an 
urban or rural poverty area, in which case the grant may cover up to 75 
percent of such costs.
    ``(3) There are authorized to be appropriated for grants under 
paragraph (1), $25,000,000 for fiscal year 1994, and such sums as may 
be necessary for each of the fiscal years 1995 through 1997.''.

                TITLE II--SEXUALLY TRANSMITTED DISEASES

SEC. 201. SHORT TITLE.

    This title may be cited as the ``Sexually Transmitted Diseases 
Amendments of 1993''.

SEC. 202. EXTENSION OF PROGRAM OF GRANTS REGARDING PREVENTION AND 
              CONTROL OF SEXUALLY TRANSMITTED DISEASES.

    (a) Extension of Program.--Section 318(d)(1) of the Public Health 
Service Act (42 U.S.C. 247c(d)(1)) is amended in the first sentence--
            (1) by striking ``(b) and (c)'' and inserting ``(b) and (c) 
        of this section and section 318B''; and
            (2) by striking ``there are authorized'' and all that 
        follows and inserting the following: ``there are authorized to 
        be appropriated $132,000,000 for fiscal year 1994, and such 
        sums as may be necessary for each of the fiscal years 1995 
        through 1997.''.
    (b) Technical Corrections.--Section 318 of the Public Health 
Service Act (42 U.S.C. 247c) is amended--
            (1) in subsection (b)(3), by striking ``, and'' and 
        inserting ``; and''; and
            (2) in subsection (d)(5)--
                    (A) in subparagraph (A), by striking ``form, or'' 
                and inserting ``form; or''; and
                    (B) in subparagraph (B), by striking ``purposes,'' 
                and inserting ``purposes;''.

SEC. 203. EXTENSION OF PROGRAM REGARDING PREVENTABLE CASES OF 
              INFERTILITY ARISING AS RESULT OF SEXUALLY TRANSMITTED 
              DISEASES.

    (a) Technical Correction.--Section 318A of the Public Health 
Service Act (42 U.S.C. 247c-1), as added by section 304 of Public Law 
102-531 (106 Stat. 3490), is amended in subsection (o)(2) by striking 
``subsection (s)'' and inserting ``subsection (q)''.
    (b) Extension of Program.--Section 318A of the Public Health 
Service Act (42 U.S.C. 247c-1), as added by section 304 of Public Law 
102-531 (106 Stat. 3490), is amended--
            (1) in subsection (q), by striking ``and 1995'' and 
        inserting ``through 1997''; and
            (2) in subsection (r)(2), by striking ``through 1995'' and 
        inserting ``through 1997''.

SEC. 204. SEXUALLY TRANSMITTED DISEASE ACCELERATED PREVENTION 
              CAMPAIGNS.

    Part B of title III of the Public Health Service Act is amended by 
inserting after section 318A (42 U.S.C. 247c-1) the following new 
section:

``SEC. 318B. SEXUALLY TRANSMITTED DISEASE ACCELERATED PREVENTION 
              CAMPAIGNS.

    ``(a) Grants.--The Secretary is authorized to award grants to 
States and political subdivisions of States for the development, 
implementation, and evaluation of innovative, interdisciplinary 
approaches to the prevention and control of sexually transmitted 
diseases and their sequelae by--
            ``(1) expanding access to sexually transmitted disease 
        services through collaborations with other public health 
        programs and with nongovernmental partners;
            ``(2) implementing community-based behavioral interventions 
        to prevent disease transmission; and
            ``(3) establishing collaborations between health 
        departments and university-based experts to strengthen sexually 
        transmitted diseases prevention programs.
    ``(b) Application.--To be eligible to receive a grant under 
subsection (a), a State or political subdivision of a State, shall 
prepare and submit to the Secretary an application at such time, in 
such manner, and containing such information as the Secretary may 
require.
    ``(c) Priority.--In awarding grants under subsection (a), the 
Secretary shall give priority to applications that seek to conduct 
activities with grant funds that focus on the prevention of sexually 
transmitted diseases among women and other populations that are 
disproportionately affected by these diseases.''.

           TITLE III--INJURY CONTROL AND VIOLENCE PREVENTION

SEC. 301. SHORT TITLE.

    This title may be cited as the ``Injury Control and Violence 
Prevention Act of 1993''.

SEC. 302. FINDINGS.

    Congress finds that--
            (1) violence or the threat of violence has adverse effects 
        on the health and safety of Americans of all ages, races, 
        ethnicities and economic conditions;
            (2) the majority of homicides and violent assaults are 
        committed by people who have relationships with their victims 
        and are not committed by strangers;
            (3) violence is being committed in private as well as 
        public, in homes, schools, and neighborhoods;
            (4) interventions by law enforcement and criminal justice 
        systems have limited ability to prevent violence;
            (5) family and interpersonal violence represent serious 
        threats to the health and well-being of millions of women in 
        the United States;
            (6) violence against women has serious health consequences 
        for its victims, including fatality, severe trauma, repeated 
        physical injuries, and chronic stress-related disorder;
            (7) violence against women has serious mental health 
        consequences for its victims, including substance abuse, severe 
        psychological trauma, and suicide;
            (8) fewer than 5 percent of injured women are correctly 
        diagnosed by medical personnel as being victims of domestic 
        violence;
            (9) hospitals and clinics do not have a uniform set of 
        protocols for the identification and referral of victims of 
        family and interpersonal violence, or for the training of 
        health care professionals to perform such functions;
            (10) a national surveillance system for monitoring the 
        health effects of injury should be established to determine the 
        nature and extent of family and interpersonal violence in the 
        United States; and
            (11) the Surgeon General has identified domestic violence 
        as a public health problem to which all health care providers 
        must actively and vigorously respond.

SEC. 303. FAMILY AND INTERPERSONAL VIOLENCE PREVENTION.

    Section 393 of the Public Health Service Act (42 U.S.C. 280b-2) is 
amended to read as follows:

``SEC. 393. PREVENTION OF FAMILY AND INTERPERSONAL VIOLENCE.

    ``(a) Research and Technical Assistance.--The Secretary, acting 
through the Director of the Centers for Disease Control and Prevention, 
may conduct research and provide technical assistance to appropriate 
public and nonprofit private entities and to academic institutions to 
assist such entities in performing research in, and conducting training 
and public health programs for, the prevention of injuries and deaths 
associated with family and interpersonal violence.
    ``(b) Grants.--The Secretary, acting through the Director of the 
Centers for Disease Control and Prevention, may award grants to States, 
political subdivisions of States, and any other public and nonprofit 
private entity for--
            ``(1) the conduct of research into identifying effective 
        strategies to prevent interpersonal violence within the family 
        and among acquaintances;
            ``(2) the development, implementation, and evaluation of 
        demonstration projects for the prevention of interpersonal 
        violence within families and among acquaintances;
            ``(3) the implementation of public information and 
        education programs for prevention of family and interpersonal 
        violence and to broaden public awareness of the public health 
        consequences of family and interpersonal violence; and
            ``(4) the provision of education, training and clinical 
        skills improvement programs for health care professionals to--
                    ``(A) routinely interview and identify individuals 
                whose medical condition or statements indicate that the 
                individuals are victims of domestic violence or sexual 
                assault; and
                    ``(B) refer the individuals to entities that 
                provide services regarding such violence and assault, 
                including referrals for counseling, housing, legal 
                services, and services of community organizations.
    ``(c) Injury Surveillance Program.--The Secretary, acting through 
the Director of the Centers for Disease Control and Prevention, shall 
support the establishment of national systematic surveillance of 
injuries, including those caused by family and interpersonal violence.
    ``(d) Definition.--As used in this section, the term `interpersonal 
violence within families and acquaintances' means any intentional 
violence, controlling, or coercive behavior or pattern of behavior by 
an individual who is currently or who was previously, in an intimate or 
acquaintance relationship with the victim. Such behavior may occur at 
any stage of the lifecycle and may encompass single acts or a syndrome 
of actual or threatened physical injury, sexual assault, rape, 
psychological abuse, or neglect. Such term includes behavior which 
currently may be described as `child neglect', `child abuse', `spousal 
abuse', `domestic violence', `woman battering', `partner abuse', `elder 
abuse', and `date rape'.
    ``(e) Application.--To be eligible to receive assistance under 
subsection (a) or (b), an entity shall prepare and submit to the 
Secretary an application at such time, in such manner, and containing 
such information as the Secretary may require.''.

SEC. 304. ADVISORY COMMITTEE; REPORTS.

    Part J of title III of the Public Health Service Act (as amended by 
Public Law 103-43) is amended by inserting after section 393 (42 U.S.C. 
280b-2) the following new section:

``SEC. 393A. GENERAL PROVISIONS.

    ``(a) Advisory Committee.--The Secretary, acting through the 
Director of the Centers for Disease Control and Prevention, shall 
establish an advisory committee to advise the Secretary and such 
Director with respect to the prevention and control of injuries.
    ``(b) Report.--Not later than February 1 of 1996 and of every 
second year thereafter, the Secretary, acting through the Director of 
the Centers for Disease Control and Prevention, shall 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 
describing the activities carried out under this part during the 
preceding 2 fiscal years. Such report shall include a description of 
such activities that were carried out with respect to domestic violence 
and sexual assault and with respect to rural areas.''.

SEC. 305. TECHNICAL CORRECTIONS.

    (a) Terminology.--Part J of title III of the Public Health Service 
Act (42 U.S.C. 280b et seq.) (as amended by Public Law 103-43) is 
amended--
            (1) in the heading for such part, by striking ``Injury 
        Control'' and inserting ``Prevention and Control of Injuries''; 
        and
            (2) in section 392--
                    (A) in the heading for such section, by inserting 
                ``prevention and'' before ``control activities'';
                    (B) in subsection (a)(1), by inserting ``and 
                control'' after ``prevention''; and
                    (C) in subsection (b)(1), by striking ``injuries 
                and injury control'' and inserting ``the prevention and 
                control of injuries''.
    (b) Provisions Relating to Public Law 102-531.--Part J of title III 
of the Public Health Service Act (42 U.S.C. 280b et seq.) (as amended 
by Public Law 103-43 (106 Stat. 3482), is amended--
            (1) in section 392(b)(2), by striking ``to promote injury 
        control'' and all that follows and inserting ``to promote 
        activities regarding the prevention and control of injuries; 
        and''; and
            (2) in section 391(b), by adding at the end the following 
        sentence: ``In carrying out the preceding sentence, the 
        Secretary shall disseminate such information to the public, 
        including through elementary and secondary schools.''.

SEC. 306. AUTHORIZATION OF APPROPRIATIONS.

    Section 394 of the Public Health Service Act (42 U.S.C. 280b-3) is 
amended--
            (1) by striking ``391 and 392'' and inserting ``391, 392, 
        and 393''; and
            (2) by striking ``$10,000,000'' and all that follows 
        through the period and inserting ``$60,000,000'' for fiscal 
        year 1994, and such sums as may be necessary for each of the 
        fiscal years 1995 through 1997.''.

            TITLE IV--BREAST AND CERVICAL CANCER AMENDMENTS

SEC. 401. SHORT TITLE.

    This title may be cited as the ``Breast and Cervical Cancer 
Amendments of 1993''.

SEC. 402. REVISIONS IN PROGRAM OF STATE GRANTS REGARDING BREAST AND 
              CERVICAL CANCER.

    (a) Limited Authority Regarding For-Profit Entities.--
            (1) In general.--Section 1501(b) of the Public Health 
        Service Act (42 U.S.C. 300k(b)) is amended--
                    (A) by striking ``States.--A State'' and all that 
                follows through ``may expend'' and inserting the 
                following: ``States.--
            ``(1) In general.--A State receiving a grant under 
        subsection (a) may, subject to paragraphs (2) and (3), 
        expend''; and
                    (B) by adding at the end the following paragraphs:
            ``(2) Limited authority regarding other entities.--In 
        addition to the authority established in paragraph (1) for a 
        State with respect to grants and contracts, the State may 
        provide for screenings under subsection (a)(1) through entering 
        into contracts with private entities.
            ``(3) Payments for screenings.--The amount paid by a State 
        to an entity under this subsection for a screening procedure 
        under subsection (a)(1) may not exceed the amount that would be 
        paid under part B of title XVIII of the Social Security Act if 
        payment were made under such part for furnishing the procedure 
        to a woman enrolled under such part.''.
            (2) Conforming amendment.--Section 1505(3) of the Public 
        Health Service Act (42 U.S.C. 300n-1(3)) is amended by 
        inserting before the semicolon the following: ``(and 
        additionally, in the case of services and activities under 
        section 1501(a)(1), with any similar services or activities of 
        private entities)''.
    (b) Special Consideration for Grants.--Section 1501 of the Public 
Health Service Act (42 U.S.C. 300k) is amended by adding at the end 
thereof the following new subsection:
    ``(c) Special Consideration.--In making grants under subsection (a) 
after the date of enactment of this subsection, the Secretary shall 
give special consideration to projects that have been peer reviewed and 
approved and that involve areas that--
            ``(1) have high cervical or breast cancer mortality rates; 
        or
            ``(2) have a high incidence of cervical or breast 
        cancer.''.
    (c) Exemption from Matching Requirements.--Section 1502(b)(1) of 
the Public Health Service Act (42 U.S.C. 300l(b)(1)) is amended to read 
as follows:
            ``(1) Types of contributions.--
                    ``(A) General rule.--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.
                    ``(B) Donated treatment services.--In meeting the 
                non-Federal contribution requirement of this section, 
                the State involved--
                            ``(i) may, with respect to a grant awarded 
                        for a program under paragraph (1) or (2) of 
                        section 1501(a), use the value of any donated 
                        outreach services associated with the delivery 
                        of breast and cervical cancer screenings 
                        conducted under the program, and the value of 
                        any additional donated breast or cervical 
                        cancer diagnostic or treatment services 
                        provided subsequent to the screening conducted 
                        under the program; and
                            ``(ii) may not, with respect to a grant 
                        awarded for a program under paragraph (3), (4), 
                        (5) or (6) of section 1501(a), include the 
                        value of any donated breast or cervical cancer 
                        outreach, diagnosis, or treatment services.''.
    (d) Requirements With Respect to Type and Quality of Services.--
            (1) In general.--Section 1503 of the Public Health Service 
        Act (42 U.S.C. 300m) is amended--
                    (A) in subsection (a)--
                            (i) in paragraph (1), to read as follows:
            ``(1) to ensure that, after a limited period of time and 
        thereafter throughout the period during which amounts are 
        received pursuant to the grant, except for the period of the 
        first year when a 50 percent minimum shall apply, 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;''; and
                            (ii) in paragraph (4), to read as follows:
            ``(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 section 1501(a), except in the 
        case of the first year during which the maximum expended for 
        these purposes shall not exceed 50 percent of the grant.''; and
                    (B) by striking subsections (c) through (e) and 
                inserting the following:
    ``(c) Quality Assurance Regarding Screening Procedures.--The 
Secretary may not make a grant under section 1501 unless the State 
involved agrees that the State will, in accordance with applicable law, 
assure the quality of screening procedures conducted pursuant to such 
section.''.
            (2) Transition rule regarding mammographies.--With respect 
        to the screening procedure for breast cancer known as a 
        mammography, the requirements in effect on the day before the 
        date of the enactment of this Act under section 1503(c) of the 
        Public Health Service Act remain in effect (for an individual 
        or facility conducting such procedures pursuant to a grant to a 
        State under section 1501 of such Act) until there is in effect 
        for the facility a certificate (or provisional certificate) 
        issued under section 354 of such Act.
    (e) Statewide Provision of Services.--Section 1504(c) of the Public 
Health Service Act (42 U.S.C. 300n(c)) is amended by adding at the end 
the following paragraph:
            ``(3) Grants to tribes and tribal organizations.--
                    ``(A) The Secretary, acting through the Director of 
                the Centers for Disease Control and Prevention, may 
                make grants to tribes and tribal organizations (as such 
                terms are used in paragraph (1)) for the purpose of 
                carrying out programs described in section 1501(a). 
                This title applies to such a grant (in relation to the 
                jurisdiction of the tribe or organization) to the same 
                extent and in the same manner as such title applies to 
                a grant to a State under section 1501 (in relation to 
                the jurisdiction of the State).
                    ``(B) If a tribe or tribal organization is 
                receiving a grant under subparagraph (A) and the State 
                in which the tribe or organization is located is 
                receiving a grant under section 1501, the requirement 
                established in paragraph (1) for the State regarding 
                the tribe or organization is deemed to have been waived 
                under paragraph (2).''.
    (f) Evaluations and Reports.--Section 1508 of the Public Health 
Service Act (42 U.S.C. 300n-4) is amended--
            (1) in subsection (a), by adding at the end the following 
        sentence: ``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).''; 
        and
            (2) in subsection (b), by inserting before the period the 
        following: ``, including recommendations regarding compliance 
        by the States with section 1501(a)(2) and with section 
        1504(c)''.
    (g) Technical Corrections.--Title XV of the Public Health Service 
Act (42 U.S.C. 300k et seq.) is amended--
            (1) in section 1501(a), in the matter preceding paragraph 
        (1), by striking ``Control,'' and inserting ``Control and 
        Prevention,''; and
            (2) in section 1505--
                    (A) in paragraph (3), by striking ``nonprivate'' 
                and inserting ``nonprofit private''; and
                    (B) in paragraph (4), by inserting ``will'' before 
                ``be used''.

SEC. 403. ESTABLISHMENT OF DEMONSTRATION PROGRAM OF GRANTS FOR 
              ADDITIONAL PREVENTIVE HEALTH SERVICES FOR WOMEN.

    (a) In General.--Title XV of the Public Health Service Act (42 
U.S.C. 300k et seq.) is amended--
            (1) by redesignating section 1509 as section 1510; and
            (2) by inserting after section 1508 the following section:

``SEC. 1509. SUPPLEMENTAL GRANTS FOR ADDITIONAL PREVENTIVE HEALTH 
              SERVICES.

    ``(a) Demonstration Projects.--In the case of States receiving 
grants under section 1501, the Secretary, acting through the Director 
of the Centers for Disease Control and Prevention, may make grants to 
not more than 3 such States to carry out demonstration projects for the 
purpose of--
            ``(1) providing preventive health services in addition to 
        the services authorized in such section, including screenings 
        regarding blood pressure and cholesterol, and including health 
        education;
            ``(2) providing appropriate referrals for medical treatment 
        of women receiving services pursuant to paragraph (1) and 
        ensuring, to the extent practicable, the provision of 
        appropriate follow-up services; and
            ``(3) evaluating activities conducted under paragraphs (1) 
        and (2) through appropriate surveillance or program-monitoring 
        activities.
    ``(b) Status as Participant in Program Regarding Breast and 
Cervical Cancer.--The Secretary may not make a grant under subsection 
(a) unless the State involved agrees that services under the grant will 
be provided only through entities that are screening women for breast 
or cervical cancer pursuant to a grant under section 1501.
    ``(c) Applicability of Provisions of General Program.--This title 
applies to a grant under subsection (a) to the same extent and in the 
same manner as such title applies to a grant under section 1501.
    ``(d) Funding.--
            ``(1) In general.--Subject to paragraph (2), for the 
        purpose of carrying out this section, there are authorized to 
        be appropriated $3,000,000 for fiscal year 1994, and such sums 
        as may be necessary for each of the fiscal years 1995 through 
        1997.
            ``(2) Limitation regarding funding with respect to breast 
        and cervical cancer.--The authorization of appropriations 
        established in paragraph (1) is not effective for a fiscal year 
        unless the amount appropriated under section 1510(a) for the 
        fiscal year equals or exceeds $100,000,000.''.
    (b) Conforming Amendment.--Section 1510(a) of the Public Health 
Service Act, as redesignated by subsection (a)(1) of this section, is 
amended in the heading for the section by striking ``funding.'' and 
inserting ``funding for general program.''.

SEC. 404. FUNDING FOR GENERAL PROGRAM.

    Section 1510(a) of the Public Health Service Act (as amended by 
section 403(a)(2)) is amended--
            (1) by striking ``and'' after ``1991,''; and
            (2) by inserting before the period the following: ``, 
        $200,000,000 for fiscal year 1994, and such sums as may be 
        necessary for each of the fiscal years 1995 through 1997''.

                   TITLE V--MISCELLANEOUS PROVISIONS

SEC. 501. EVALUATIONS.

    Section 2711 of the Public Health Service Act (42 U.S.C. 300aaa-10) 
is amended to read as follows:

                        ``evaluation of programs

    ``Sec. 2711. (a) In General.--Such portion as the Secretary shall 
determine, but not less than .2 percent nor more than 1 percent, of any 
amounts appropriated for programs authorized under this Act for any 
fiscal year beginning after September 20, 1993, shall be made available 
for the evaluation (directly, or by grants of contracts) of the 
implementation and effectiveness of such programs.
    ``(b) Report on Evaluations.--
            ``(1) In general.--To provide information for legislative 
        deliberations concerning Federal health programs, the Secretary 
        shall, not later than January 1 of each year, prepare and 
        submit to the Committee on Labor and Human Resources of the 
        Senate and the Committee on Energy and Commerce of the House of 
        Representatives a report that identifies and synthesizes the 
        findings of the evaluations conducted under subsection (a) by 
        program area. Such report shall also include the plans of the 
        Secretary for the subsequent year's evaluations, including 
        programs and issue areas.
            ``(2) Five year review.--A report submitted under paragraph 
        (1) shall contain a description of the findings of the 
        Secretary with respect to evaluations conducted under 
        subsection (a) or other provisions of law, during the 5-year 
        period prior to the year for which the report is being 
        submitted. Such description shall provide the Committees 
        referred to in paragraph (1) with information concerning 
        program changes that the Secretary intends to implement in 
        response to such findings in order to improve the health of the 
        American people and their receipt of needed and effective 
        public health services.''.

SEC. 502. FEDERAL BENEFITS FOR OVERSEAS ASSIGNEES.

    Section 307 of the Public Health Service Act (42 U.S.C. 242l) is 
amended by adding at the end thereof the following new subsection:
    ``(c) The Secretary may provide to personnel appointed or assigned 
by the Secretary to serve abroad, allowances and benefits similar to 
those provided under chapter 9 of title I of the Foreign Service Act of 
1990 (22 U.S.C. 4081 et seq.). Leaves of absence for personnel under 
this subsection shall be on the same basis as that provided under 
subchapter I of chapter 63 of title 5, United States Code to 
individuals serving in the Foreign Service.''.

SEC. 503. LOAN REPAYMENT PROGRAM.

    Part J of title III of the Public Health Service Act (as amended by 
section 2008 of Public Law 103-43) is amended by inserting after 
section 393A (as added by section 304) the following new section:

``SEC. 393B. LOAN REPAYMENT PROGRAM.

    ``(a) In General.--
            ``(1) Authority.--Subject to paragraph (2), the Secretary 
        may carry out a program of entering into contracts with 
        appropriately qualified health professionals under which such 
        health professionals agree to conduct prevention activities, as 
        employees of the Centers for Disease Control and Prevention and 
        the Agency for Toxic Substances and Disease Registry, in 
        consideration of the Federal Government agreeing to repay, for 
        each year of such service, not more than $20,000 of the 
        principal and interest of the educational loans of such health 
        professionals.
            ``(2) Limitation.--The Secretary may not enter into an 
        agreement with a health professional pursuant to paragraph (1) 
        unless such professional--
                    ``(A) has a substantial amount of educational loans 
                relative to income; and
                    ``(B) agrees to serve as an employee of the Centers 
                for Disease Control and Prevention or the Agency for 
                Toxic Substances and Disease Registry for purposes of 
                paragraph (1) for a period of not less than 3 years.
    ``(b) Applicability of Certain Provisions.--With respect to the 
National Health Service Corps Loan Repayment Program established in 
subpart III of part D of title III of this Act, the provisions of such 
subpart shall, except as inconsistent with subsection (a), apply to the 
program established in this section in the same manner and to the same 
extent as such provisions apply to the National Health Service Corps 
Loan Repayment Program.
    ``(c) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated $500,000 for 
each of the fiscal years 1994 through 1997.''.

SEC. 504. ESTABLISHMENT OF REQUIREMENT OF BIENNIAL REPORT ON NUTRITION 
              AND HEALTH.

    Title XVII of the Public Health Service Act (42 U.S.C. 300u et 
seq.), as amended by section 302 of Public Law 102-531 (106 Stat. 
3483), is amended by adding at the end the following section:

            ``biennial report regarding nutrition and health

    ``Sec. 1709. (a) Biennial Report.--The Secretary shall require the 
Surgeon General of the Public Health Service to prepare biennial 
reports on the relationship between nutrition and health. Such reports 
may, with respect to such relationship, include any recommendations of 
the Secretary and the Surgeon General regarding the public health.
    ``(b) Submission to Congress.--The Secretary shall ensure that, not 
later than February 1 of 1995 and of every second year thereafter, a 
report under subsection (a) is submitted to the Committee on Energy and 
Commerce of the House of Representatives and the Committee on Labor and 
Human Resources of the Senate.
    ``(c) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated such sums as 
may be necessary for each of the fiscal years 1994 through 1997.''.

SEC. 505. ALIGNMENT OF CURRENT CENTERS FOR DISEASE CONTROL AND 
              PREVENTION REAUTHORIZATION SCHEDULE.

    (a) Prostate Cancer Prevention.--Section 317D((l)(1) of such Act 
(42 U.S.C. 247b-5(l)(1)) is amended by striking ``through 1996'' and 
inserting ``through 1997''.
    (b) Cancer Registries.--Section 399L(a) of such Act (42 U.S.C. 
280e-4(a)) (as amended by section 2003(1) of Public Law 103-43) is 
amended by striking ``through 1996'' and inserting ``through 1997''.
    (c) Health Promotion and Disease Prevention Research and 
Demonstration Centers.--Section 1706(e) of such Act (42 U.S.C. 300u-
5(e)) is amended by striking ``through 1996'' and inserting ``through 
1997''.
    (d) Sense of Congress.--It is the sense of Congress that, beginning 
on the date of enactment of this Act and continuing through fiscal year 
1997, all Acts regarding the authorization or reauthorization of 
Centers for Disease Control and Prevention programs should be 
authorized only through fiscal year 1997. Beginning in fiscal year 
1997, Congress should reauthorize the Centers for Disease Control and 
Prevention and its programs in one comprehensive Act. After fiscal year 
1997, reauthorization of such Centers and its programs should occur on 
a regular cyclical basis.

SEC. 506. BREAST AND CERVICAL CANCER INFORMATION.

    Title XXVII of the Public Health Service Act (42 U.S.C. 300aaa et 
seq.) is amended by adding at the end the following new section:

``SEC. 2715. BREAST AND CERVICAL CANCER INFORMATION.

    ``(a) In General.--Each of the entities referred to in subsection 
(b) shall make available, to such individuals as the entities determine 
appropriate, information (in a culturally competent manner) concerning 
breast and cervical cancer, including if appropriate, information on 
the need for breast self-examinations and the skills for such self-
examinations, and shall refer such clients as the entities determine 
appropriate for breast and cervical cancer screening, treatment or 
other services.
    ``(b) Entities.--The entities referred to in subsection (a) are--
            ``(1) a migrant health center receiving assistance under 
        section 329;
            ``(2) a community health center receiving assistance under 
        section 330;
            ``(3) an entity receiving assistance under section 340;
            ``(4) an alcohol or drug treatment entity or mental health 
        entity receiving assistance under title V or title XIX;
            ``(5) a family planning project described in section 1001;
            ``(6) an entity receiving assistance under title XXVI;
            ``(7) a clinic that treats sexually transmitted diseases 
        and is authorized under section 318;
            ``(8) an entity receiving funds to provide primary health 
        services to residents of public housing under section 340A;
            ``(9) a non-Federal entity authorized under the Indian 
        Self-Determination Act; and
            ``(10) a tuberculosis clinic receiving assistance under 
        section 317(j)(2) or 317(k)(2).''.

SEC. 507. PAYMENT OF JUDGMENTS.

    Section 224(k)(2) of the Public Health Service Act (42 U.S.C. 
233(k)(2)), as added by section 4 of the Federally Supported Health 
Centers Assistance Act of 1992, is amended by adding at the end thereof 
the following new sentence: ``Appropriations for purposes of this 
paragraph shall be made separate from appropriations made for purposes 
of sections 329, 330, 340 and 340A.''.

SEC. 508. INTERIM FINAL REGULATIONS.

    The Secretary of Health and Human Services is authorized to issue 
interim final regulations--
            (1) under which the Secretary may approve accreditation 
        bodies under section 354(e) of the Public Health Service Act 
        (42 U.S.C. 263b(e)); and
            (2) establishing quality standards under section 354(f) of 
        the Public Health Service Act (42 U.S.C. 263b(f)).

            Attest:






                                                             Secretary.

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