[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4093 Introduced in House (IH)]






108th CONGRESS
  2d Session
                                H. R. 4093

To amend the Public Health Service Act to establish a program of grants 
          for the detection and control of colorectal cancer.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 31, 2004

 Mr. Kennedy of Rhode Island introduced the following bill; which was 
            referred to the Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
To amend the Public Health Service Act to establish a program of grants 
          for the detection and control of colorectal cancer.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Colorectal Cancer Mortality 
Prevention Act of 2004''.

SEC. 2. ESTABLISHMENT OF PROGRAM OF GRANTS TO STATES FOR DETECTION AND 
              CONTROL OF COLORECTAL CANCER.

    The Public Health Service Act (42 U.S.C. 201 et seq.) is amended by 
inserting after title XXVIII the following new title:

  ``TITLE XXIX--PREVENTIVE HEALTH MEASURES WITH RESPECT TO COLORECTAL 
                                CANCERS

``SEC. 2901. ESTABLISHMENT OF PROGRAM OF GRANTS TO STATES.

    ``(a) In General.--The Secretary, acting through the Director of 
the Centers for Disease Control and Prevention, may make grants to 
States on the basis of an established competitive review process for 
the purpose of carrying out programs--
            ``(1) to screen for colorectal cancer as a preventive 
        health measure;
            ``(2) to provide appropriate referrals for medical 
        treatment of individuals screened pursuant to paragraph (1) and 
        to ensure, to the extent practicable, the provision of 
        appropriate follow-up services;
            ``(3) to develop and disseminate public information and 
        education programs for the detection and control of colorectal 
        cancer;
            ``(4) to improve the education, training, and skills of 
        health professionals (including allied health professionals) in 
        the detection and control of colorectal cancer;
            ``(5) to establish mechanisms through which the States can 
        monitor the quality of screening procedures for colorectal 
        cancer, including the interpretation of such procedures; and
            ``(6) to evaluate activities conducted under paragraphs (1) 
        through (5) through appropriate surveillance or program-
        monitoring activities.
    ``(b) Grant and Contract Authority of States.--A State receiving a 
grant under subsection (a) may expend the grant to carry out the 
purpose described in such subsection through grants to, and contracts 
with, public or nonprofit private entities.

``SEC. 2902. REQUIREMENT OF MATCHING FUNDS.

    ``(a) In General.--The Secretary may not make a grant under section 
2901 unless the State involved agrees, with respect to the costs to be 
incurred by the State in carrying out the purpose described in such 
section, to make available non-Federal contributions (in cash or in 
kind under subsection (b)) toward such costs in an amount that is not 
less than $1 for each $3 of Federal funds provided in the grant. Such 
contributions may be made directly or through donations from public or 
private entities.
    ``(b) Determination of Amount of Non-Federal Contribution.--
            ``(1) In general.--Non-Federal contributions required in 
        subsection (a) may be in cash or in kind, fairly evaluated, 
        including equipment or services (and excluding indirect or 
        overhead costs). Amounts provided by the Federal Government, or 
        services assisted or subsidized to any significant extent by 
        the Federal Government, may not be included in determining the 
        amount of such non-Federal contributions.
            ``(2) Maintenance of effort.--In making a determination of 
        the amount of non-Federal contributions for purposes of 
        subsection (a), the Secretary may include only non-Federal 
        contributions in excess of the average amount of non-Federal 
        contributions made by the State involved toward the purpose 
        described in section 2901 for the 2-year period preceding the 
        first fiscal year for which the State is applying to receive a 
        grant under such section.
            ``(3) Inclusion of relevant non-federal contributions for 
        medicaid.--In making a determination of the amount of non-
        Federal contributions for purposes of subsection (a), the 
        Secretary shall, subject to paragraphs (1) and (2) of this 
        subsection, include any non-Federal amounts expended pursuant 
        to title XIX of the Social Security Act by the State involved 
        toward the purpose described in paragraphs (1) and (2) of 
        section 2901(a).

``SEC. 2903. REQUIREMENTS WITH RESPECT TO TYPE AND QUALITY OF SERVICES.

    ``(a) Requirement of Provision of All Services by Date Certain.--
The Secretary may not make a grant under section 2901 unless the State 
involved agrees--
            ``(1) to ensure that, initially and throughout the period 
        during which amounts are received pursuant to the grant, not 
        less than 60 percent of the grant is expended to provide each 
        of the services or activities described in paragraphs (1) and 
        (2) of section 2901(a), including making available screening 
        procedures for colorectal cancer;
            ``(2) to ensure that, by the end of any second fiscal year 
        of payments pursuant to the grant, each of the services or 
        activities described in section 2901(a) is provided; and
            ``(3) to ensure that not more than 40 percent of the grant 
        is expended to provide the services or activities described in 
        paragraphs (3) through (6) of such section.
    ``(b) Quality Assurance Regarding Screening for Colorectal 
Cancer.--The Secretary may not make a grant under section 2901 unless 
the State involved--
            ``(1) assures the quality of any screening procedure for 
        colorectal cancer conducted pursuant to such section; and
            ``(2) assures that, with respect to the first colorectal 
        cancer screening performed on an individual for which payment 
        is made pursuant to section 2901(a), there are satisfactory 
        assurances that the results of the screening will be placed in 
        permanent medical records maintained with respect to the 
        individual.
    ``(c) Issuance by Secretary of Guidelines With Respect to Quality 
of Colorectal Services.--
            ``(1) In general.--The Secretary shall issue guidelines for 
        assuring the quality of any colorectal screening procedure 
        conducted pursuant to section 2901(a).
            ``(2) Applicability with respect to grants.--The Secretary 
        may not make a grant under section 2901 unless the State 
        involved agrees that the State will, with respect to any 
        colorectal screening procedure conducted pursuant to such 
        section, ensure that the procedure is conducted in accordance 
        with the guidelines issued by the Secretary under paragraph 
        (1).

``SEC. 2904. ADDITIONAL REQUIRED AGREEMENTS.

    ``(a) Priority for Low-Income Individuals.--The Secretary may not 
make a grant under section 2901 unless the State involved agrees that 
low-income individuals will be given priority in the provision of 
services and activities pursuant to paragraphs (1) and (2) of section 
2901(a).
    ``(b) Limitation on Imposition of Fees for Services.--The Secretary 
may not make a grant under section 2901 unless the State involved 
agrees that, if a charge is imposed for the provision of services or 
activities under the grant, such charge--
            ``(1) will be made according to a schedule of charges that 
        is made available to the public;
            ``(2) will be adjusted to reflect the income of the 
        individuals involved; and
            ``(3) will not be imposed on any individual with an income 
        of less than 100 percent of the official poverty line, as 
        established by the Director of the Office of Management and 
        Budget and revised by the Secretary in accordance with section 
        673(2) of the Omnibus Budget Reconciliation Act of 1981.
    ``(c) Statewide Provision of Services.--
            ``(1) In general.--The Secretary may not make a grant under 
        section 2901 unless the State involved agrees that services and 
        activities under the grant will be made available throughout 
        the State, including availability to members of any Indian 
        tribe or tribal organization (as such terms are defined in 
        section 4 of the Indian Self-Determination and Education 
        Assistance Act).
            ``(2) Waiver.--The Secretary may waive the requirement 
        established in paragraph (1) for a State if the Secretary 
        determines that compliance by the State with the requirement 
        would result in an inefficient allocation of resources with 
        respect to carrying out the purpose described in section 
        2901(a).
    ``(d) Relationship to Items and Services Under Other Programs.--The 
Secretary may not make a grant under section 2901 unless the State 
involved agrees that the grant will not be expended to make payment for 
any item or service to the extent that payment has been made, or can 
reasonably be expected to be made, with respect to such item or 
service--
            ``(1) under any State compensation program, under an 
        insurance policy, or under any Federal or State health benefits 
        program; or
            ``(2) by an entity that provides health services on a 
        prepaid basis.
    ``(e) Coordination With Other Colorectal Cancer Programs.--The 
Secretary may not make a grant under section 2901 unless the State 
involved agrees that the services and activities funded through the 
grant will be coordinated with other Federal, State, and local 
colorectal cancer programs.
    ``(f) Limitation on Administrative Expenses.--The Secretary may not 
make a grant under section 2901 unless the State involved agrees that 
not more than 10 percent of the grant will be expended for 
administrative expenses with respect to the grant.
    ``(g) Restrictions on Use of Grant.--The Secretary may not make a 
grant under section 2901 unless the State involved agrees that the 
grant will not be expended to provide inpatient hospital services (as 
that term is defined by the Secretary for purposes of this subsection).
    ``(h) Records and Audits.--The Secretary may not make a grant under 
section 2901 unless the State involved agrees that--
            ``(1) the State will establish such fiscal control and fund 
        accounting procedures as may be necessary to ensure the proper 
        disbursement of, and accounting for, amounts received by the 
        State under such section; and
            ``(2) upon request, the State will provide records 
        maintained pursuant to paragraph (1) to the Secretary or the 
        Comptroller General of the United States for purposes of 
        auditing the expenditures by the State of the grant.
    ``(i) Reports to Secretary.--The Secretary may not make a grant 
under section 2901 unless the State involved agrees to submit to the 
Secretary such reports as the Secretary may require with respect to the 
grant.

``SEC. 2905. DESCRIPTION OF INTENDED USES OF GRANT.

    ``The Secretary may not make a grant under section 2901 unless--
            ``(1) the State involved submits to the Secretary a 
        description of the purposes for which the State intends to 
        expend the grant;
            ``(2) the description identifies the populations, areas, 
        and localities in the State with a need for the services or 
        activities described in section 2901(a);
            ``(3) the description provides information relating to the 
        services and activities to be provided, including a description 
        of the manner in which the services and activities will be 
        coordinated with any similar services or activities of public 
        or nonprofit entities; and
            ``(4) the description provides assurances that the grant 
        funds be used in the most cost-effective manner.

``SEC. 2906. REQUIREMENT OF SUBMISSION OF APPLICATION.

    ``The Secretary may not make a grant under section 2901 unless an 
application for the grant is submitted to the Secretary, the 
application contains the description of intended uses required in 
section 2905, and the application is in such form, is made in such 
manner, and contains such agreements, assurances, and information as 
the Secretary determines to be necessary to carry out this title.

``SEC. 2907. TECHNICAL ASSISTANCE AND PROVISION OF SUPPLIES AND 
              SERVICES IN LIEU OF GRANT FUNDS.

    ``(a) Technical Assistance.--The Secretary may provide training and 
technical assistance with respect to the planning, development, and 
operation of any program or service carried out pursuant to section 
2901. The Secretary may provide such technical assistance directly or 
through grants to, or contracts with, public and private entities.
    ``(b) Provision of Supplies and Services in Lieu of Grant Funds.--
            ``(1) In general.--Upon the request of a State receiving a 
        grant under section 2901, the Secretary may, subject to 
        paragraph (2), provide supplies, equipment, and services for 
        the purpose of aiding the State in carrying out such section 
        and, for such purpose, may detail to the State any officer or 
        employee of the Department of Health and Human Services.
            ``(2) Corresponding reduction in payments.--With respect to 
        a request described in paragraph (1), the Secretary shall 
        reduce the amount of payments under the grant under section 
        2901 to the State involved by an amount equal to the costs of 
        detailing personnel (including pay, allowances, and travel 
        expenses) and the fair market value of any supplies, equipment, 
        or services provided by the Secretary. The Secretary shall, for 
        the payment of expenses incurred in complying with such 
        request, expend the amounts withheld.

``SEC. 2908. 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 2901.
    ``(b) Report to Congress.--The Secretary shall, not later than 1 
year after the date on which amounts are first appropriated to carry 
out section 2909(a), and annually thereafter, submit to the appropriate 
congressional committees a report summarizing evaluations carried out 
pursuant to subsection (a) during the preceding fiscal year and making 
such recommendations for administrative and legislative initiatives 
with respect to this title as the Secretary determines to be 
appropriate.

``SEC. 2909. FUNDING.

    ``(a) Authorization of Appropriations.--For the purpose of carrying 
out this title, there is authorized to be appropriated $25,000,000 for 
each of the fiscal years 2005 through 2008.
    ``(b) Set-Aside for Technical Assistance and Provision of Supplies 
and Services.--Of the amounts appropriated under subsection (a) for a 
fiscal year, the Secretary shall reserve not more than 10 percent for 
carrying out section 2907.''.
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