[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 898 Reported in Senate (RS)]






                                                       Calendar No. 115
109th CONGRESS
  1st Session
                                 S. 898

                          [Report No. 109-73]

  To amend the Public Health Service Act to authorize a demonstration 
grant program to provide patient navigator services to reduce barriers 
       and improve health care outcomes, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             April 25, 2005

Mrs. Hutchison (for herself, Mr. Bingaman, Mr. Brownback, Mr. Kennedy, 
 and Mr. Cochran) introduced the following bill; which was read twice 
and referred to the Committee on Health, Education, Labor, and Pensions

                              May 25, 2005

                Reported by Mr. Enzi, with an amendment
 [Strike out all after the enacting clause and insert the part printed 
                               in italic]

_______________________________________________________________________

                                 A BILL


 
  To amend the Public Health Service Act to authorize a demonstration 
grant program to provide patient navigator services to reduce barriers 
       and improve health care outcomes, and for other purposes.

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

<DELETED>SECTION 1. SHORT TITLE.</DELETED>

<DELETED>    This Act may be cited as the ``Patient Navigator Outreach 
and Chronic Disease Prevention Act of 2005''.</DELETED>

<DELETED>SEC. 2. PATIENT NAVIGATOR GRANTS.</DELETED>

<DELETED>    Subpart V of part D of title III of the Public Health 
Service Act (42 U.S.C. 256) is amended by adding at the end the 
following:</DELETED>

<DELETED>``SEC. 340A. PATIENT NAVIGATOR GRANTS.</DELETED>

<DELETED>    ``(a) Grants.--The Secretary, acting through the 
Administrator of the Health Resources and Services Administration, may 
make grants to eligible entities for the development and operation of 
demonstration programs to provide patient navigator services to improve 
health care outcomes. The Secretary shall coordinate with, and ensure 
the participation of, the Indian Health Service, the National Cancer 
Institute, the Office of Rural Health Policy, and such other offices 
and agencies as deemed appropriate by the Secretary, regarding the 
design and evaluation of the demonstration programs.</DELETED>
<DELETED>    ``(b) Use of Funds.--The Secretary shall require each 
recipient of a grant under this section to use the grant to recruit, 
assign, train, and employ patient navigators who have direct knowledge 
of the communities they serve to facilitate the care of individuals, 
including by performing each of the following duties:</DELETED>
        <DELETED>    ``(1) Acting as contacts, including by assisting 
        in the coordination of health care services and provider 
        referrals, for individuals who are seeking prevention or early 
        detection services for, or who following a screening or early 
        detection service are found to have a symptom, abnormal 
        finding, or diagnosis of, cancer or other chronic 
        disease.</DELETED>
        <DELETED>    ``(2) Facilitating the involvement of community 
        organizations in assisting individuals who are at risk for or 
        who have cancer or other chronic diseases to receive better 
        access to high-quality health care services (such as by 
        creating partnerships with patient advocacy groups, charities, 
        health care centers, community hospice centers, other health 
        care providers, or other organizations in the targeted 
        community).</DELETED>
        <DELETED>    ``(3) Notifying individuals of clinical trials 
        and, on request, facilitating enrollment of eligible 
        individuals in these trials.</DELETED>
        <DELETED>    ``(4) Anticipating, identifying, and helping 
        patients to overcome barriers within the health care system to 
        ensure prompt diagnostic and treatment resolution of an 
        abnormal finding of cancer or other chronic disease.</DELETED>
        <DELETED>    ``(5) Coordinating with the relevant health 
        insurance ombudsman programs to provide information to 
        individuals who are at risk for or who have cancer or other 
        chronic diseases about health coverage, including private 
        insurance, health care savings accounts, and other publicly 
        funded programs (such as Medicare, Medicaid, health programs 
        operated by the Department of Veterans Affairs or the 
        Department of Defense, the State children's health insurance 
        program, and any private or governmental prescription 
        assistance programs).</DELETED>
        <DELETED>    ``(6) Conducting ongoing outreach to health 
        disparity populations, including the uninsured, rural 
        populations, and other medically underserved populations, in 
        addition to assisting other individuals who are at risk for or 
        who have cancer or other chronic diseases to seek preventative 
        care.</DELETED>
<DELETED>    ``(c) Prohibitions.--</DELETED>
        <DELETED>    ``(1) Referral fees.--The Secretary shall require 
        each recipient of a grant under this section to prohibit any 
        patient navigator providing services under the grant from 
        accepting any referral fee, kickback, or other thing of value 
        in return for referring an individual to a particular health 
        care provider.</DELETED>
        <DELETED>    ``(2) Legal fees and costs.--The Secretary shall 
        prohibit the use of any grant funds received under this section 
        to pay any fees or costs resulting from any litigation, 
        arbitration, mediation, or other proceeding to resolve a legal 
        dispute.</DELETED>
<DELETED>    ``(d) Grant Period.--</DELETED>
        <DELETED>    ``(1) In general.--Subject to paragraphs (2) and 
        (3), the Secretary may award grants under this section for 
        periods of not more than 3 years.</DELETED>
        <DELETED>    ``(2) Extensions.--Subject to paragraph (3), the 
        Secretary may extend the period of a grant under this section. 
        Each such extension shall be for a period of not more than 1 
        year.</DELETED>
        <DELETED>    ``(3) Limitations on grant period.--In carrying 
        out this section, the Secretary--</DELETED>
                <DELETED>    ``(A) shall ensure that the total period 
                of a grant does not exceed 4 years; and</DELETED>
                <DELETED>    ``(B) may not authorize any grant period 
                ending after September 30, 2010.</DELETED>
<DELETED>    ``(e) Application.--</DELETED>
        <DELETED>    ``(1) In general.--To seek a grant under this 
        section, an eligible entity shall submit an application to the 
        Secretary in such form, in such manner, and containing such 
        information as the Secretary may require.</DELETED>
        <DELETED>    ``(2) Contents.--At a minimum, the Secretary shall 
        require each such application to outline how the eligible 
        entity will establish baseline measures and benchmarks that 
        meet the Secretary's requirements to evaluate program 
        outcomes.</DELETED>
<DELETED>    ``(f) Uniform Baseline Measures.--The Secretary shall 
establish uniform baseline measures in order to properly evaluate the 
impact of the demonstration projects under this section.</DELETED>
<DELETED>    ``(g) Preference.--In making grants under this section, 
the Secretary shall give preference to eligible entities that 
demonstrate in their applications plans to utilize patient navigator 
services to overcome significant barriers in order to improve health 
care outcomes in their respective communities.</DELETED>
<DELETED>    ``(h) Duplication of Services.--An eligible entity that is 
receiving Federal funds for activities described in subsection (b) on 
the date on which the entity submits an application under subsection 
(e), may not receive a grant under this section unless the entity can 
demonstrate that amounts received under the grant will be utilized to 
expand services or provide new services to individuals who would not 
otherwise be served.</DELETED>
<DELETED>    ``(i) Coordination With Other Programs.--The Secretary 
shall ensure coordination of the demonstration grant program under this 
section with existing authorized programs in order to facilitate access 
to high-quality health care services.</DELETED>
<DELETED>    ``(j) Study; Reports.--</DELETED>
        <DELETED>    ``(1) Final report by secretary.--Not later than 6 
        months after the completion of the demonstration grant program 
        under this section, the Secretary shall conduct a study of the 
        results of the program and submit to the Congress a report on 
        such results that includes the following:</DELETED>
                <DELETED>    ``(A) An evaluation of the program 
                outcomes, including--</DELETED>
                        <DELETED>    ``(i) quantitative analysis of 
                        baseline and benchmark measures; and</DELETED>
                        <DELETED>    ``(ii) aggregate information about 
                        the patients served and program 
                        activities.</DELETED>
                <DELETED>    ``(B) Recommendations on whether patient 
                navigator programs could be used to improve patient 
                outcomes in other public health areas.</DELETED>
        <DELETED>    ``(2) Reports by secretary.--The Secretary may 
        provide interim reports to the Congress on the demonstration 
        grant program under this section at such intervals as the 
        Secretary determines to be appropriate.</DELETED>
        <DELETED>    ``(3) Interim reports by grantees.--The Secretary 
        may require grant recipients under this section to submit 
        interim and final reports on grant program outcomes.</DELETED>
<DELETED>    ``(k) Rule of Construction.--This section shall not be 
construed to authorize funding for the delivery of health care services 
(other than the patient navigator duties listed in subsection 
(b)).</DELETED>
<DELETED>    ``(l) Definitions.--In this section:</DELETED>
        <DELETED>    ``(1) The term `eligible entity' means a public or 
        nonprofit private health center (including a Federally 
        qualified health center (as that term is defined in section 
        1861(aa)(4) of the Social Security Act)), a health facility 
        operated by or pursuant to a contract with the Indian Health 
        Service, a hospital, a cancer center, a rural health clinic, an 
        academic health center, or a nonprofit entity that enters into 
        a partnership or coordinates referrals with such a center, 
        clinic, facility, or hospital to provide patient navigator 
        services.</DELETED>
        <DELETED>    ``(2) The term `health disparity population' means 
        a population that, as determined by the Secretary, has a 
        significant disparity in the overall rate of disease incidence, 
        prevalence, morbidity, mortality, or survival rates as compared 
        to the health status of the general population.</DELETED>
        <DELETED>    ``(3) The term `patient navigator' means an 
        individual who has completed a training program approved by the 
        Secretary to perform the duties listed in subsection 
        (b).</DELETED>
<DELETED>    ``(m) Authorization of Appropriations.--</DELETED>
        <DELETED>    ``(1) In general.--To carry out this section, 
        there are authorized to be appropriated $2,000,000 for fiscal 
        year 2006, $5,000,000 for fiscal year 2007, $8,000,000 for 
        fiscal year 2008, $6,500,000 for fiscal year 2009, and 
        $3,500,000 for fiscal year 2010.</DELETED>
        <DELETED>    ``(2) Availability.--The amounts appropriated 
        pursuant to paragraph (1) shall remain available for obligation 
        through the end of fiscal year 2010.''.</DELETED>

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Patient Navigator Outreach and 
Chronic Disease Prevention Act of 2005''.

SEC. 2. PATIENT NAVIGATOR GRANTS.

    Subpart V of part D of title III of the Public Health Service Act 
(42 U.S.C. 256) is amended by adding at the end the following:

``SEC. 340A. PATIENT NAVIGATOR GRANTS.

    ``(a) Grants.--The Secretary, acting through the Administrator of 
the Health Resources and Services Administration, may make grants to 
eligible entities for the development and operation of demonstration 
programs to provide patient navigator services to improve health care 
outcomes. The Secretary shall coordinate with, and ensure the 
participation of, the Indian Health Service, the National Cancer 
Institute, the Office of Rural Health Policy, and such other offices 
and agencies as deemed appropriate by the Secretary, regarding the 
design and evaluation of the demonstration programs.
    ``(b) Use of Funds.--The Secretary shall require each recipient of 
a grant under this section to use the grant to recruit, assign, train, 
and employ patient navigators who have direct knowledge of the 
communities they serve to facilitate the care of individuals, including 
by performing each of the following duties:
            ``(1) Acting as contacts, including by assisting in the 
        coordination of health care services and provider referrals, 
        for individuals who are seeking prevention or early detection 
        services for, or who following a screening or early detection 
        service are found to have a symptom, abnormal finding, or 
        diagnosis of, cancer or other chronic disease.
            ``(2) Facilitating the involvement of community 
        organizations in assisting individuals who are at risk for or 
        who have cancer or other chronic diseases to receive better 
        access to high-quality health care services (such as by 
        creating partnerships with patient advocacy groups, charities, 
        health care centers, community hospice centers, other health 
        care providers, or other organizations in the targeted 
        community).
            ``(3) Notifying individuals of clinical trials and, on 
        request, facilitating enrollment of eligible individuals in 
        these trials.
            ``(4) Anticipating, identifying, and helping patients to 
        overcome barriers within the health care system to ensure 
        prompt diagnostic and treatment resolution of an abnormal 
        finding of cancer or other chronic disease.
            ``(5) Coordinating with the relevant health insurance 
        ombudsman programs to provide information to individuals who 
        are at risk for or who have cancer or other chronic diseases 
        about health coverage, including private insurance, health care 
        savings accounts, and other publicly funded programs (such as 
        Medicare, Medicaid, health programs operated by the Department 
        of Veterans Affairs or the Department of Defense, the State 
        children's health insurance program, and any private or 
        governmental prescription assistance programs).
            ``(6) Conducting ongoing outreach to health disparity 
        populations, including the uninsured, rural populations, and 
        other medically underserved populations, in addition to 
        assisting other individuals who are at risk for or who have 
        cancer or other chronic diseases to seek preventative care.
    ``(c) Prohibitions.--
            ``(1) Referral fees.--The Secretary shall require each 
        recipient of a grant under this section to prohibit any patient 
        navigator providing services under the grant from accepting any 
        referral fee, kickback, or other thing of value in return for 
        referring an individual to a particular health care provider.
            ``(2) Legal fees and costs.--The Secretary shall prohibit 
        the use of any grant funds received under this section to pay 
        any fees or costs resulting from any litigation, arbitration, 
        mediation, or other proceeding to resolve a legal dispute.
    ``(d) Grant Period.--
            ``(1) In general.--Subject to paragraphs (2) and (3), the 
        Secretary may award grants under this section for periods of 
        not more than 3 years.
            ``(2) Extensions.--Subject to paragraph (3), the Secretary 
        may extend the period of a grant under this section. Each such 
        extension shall be for a period of not more than 1 year.
            ``(3) Limitations on grant period.--In carrying out this 
        section, the Secretary--
                    ``(A) shall ensure that the total period of a grant 
                does not exceed 4 years; and
                    ``(B) may not authorize any grant period ending 
                after September 30, 2010.
    ``(e) Application.--
            ``(1) In general.--To seek a grant under this section, an 
        eligible entity shall submit an application to the Secretary in 
        such form, in such manner, and containing such information as 
        the Secretary may require.
            ``(2) Contents.--At a minimum, the Secretary shall require 
        each such application to outline how the eligible entity will 
        establish baseline measures and benchmarks that meet the 
        Secretary's requirements to evaluate program outcomes.
    ``(f) Uniform Baseline Measures.--The Secretary shall establish 
uniform baseline measures in order to properly evaluate the impact of 
the demonstration projects under this section.
    ``(g) Preference.--In making grants under this section, the 
Secretary shall give preference to eligible entities that demonstrate 
in their applications plans to utilize patient navigator services to 
overcome significant barriers in order to improve health care outcomes 
in their respective communities.
    ``(h) Duplication of Services.--An eligible entity that is 
receiving Federal funds for activities described in subsection (b) on 
the date on which the entity submits an application under subsection 
(e), may not receive a grant under this section unless the entity can 
demonstrate that amounts received under the grant will be utilized to 
expand services or provide new services to individuals who would not 
otherwise be served.
    ``(i) Coordination With Other Programs.--The Secretary shall ensure 
coordination of the demonstration grant program under this section with 
existing authorized programs in order to facilitate access to high-
quality health care services.
    ``(j) Study; Reports.--
            ``(1) Final report by secretary.--Not later than 180 days 
        after the completion of the demonstration grant program under 
        this section, the Secretary shall conduct a study of the 
        results of the program and submit to the Congress a report on 
        such results that includes the following:
                    ``(A) An evaluation of the program outcomes, 
                including--
                            ``(i) quantitative analysis of baseline and 
                        benchmark measures; and
                            ``(ii) aggregate information about the 
                        patients served and program activities.
                    ``(B) Recommendations on whether patient navigator 
                programs could be used to improve patient outcomes in 
                other public health areas.
            ``(2) Reports by secretary.--The Secretary may provide 
        interim reports to the Congress on the demonstration grant 
        program under this section at such intervals as the Secretary 
        determines to be appropriate.
            ``(3) Interim reports by grantees.--The Secretary may 
        require grant recipients under this section to submit interim 
        and final reports on grant program outcomes.
    ``(k) Rule of Construction.--This section shall not be construed to 
authorize funding for the delivery of health care services (other than 
the patient navigator duties listed in subsection (b)).
    ``(l) Definitions.--In this section:
            ``(1) The term `eligible entity' means a public or 
        nonprofit private health center (including a Federally 
        qualified health center (as that term is defined in section 
        1861(aa)(4) of the Social Security Act)), a health facility 
        operated by or pursuant to a contract with the Indian Health 
        Service, a hospital, a cancer center, a rural health clinic, an 
        academic health center, or a nonprofit entity that enters into 
        a partnership or coordinates referrals with such a center, 
        clinic, facility, or hospital to provide patient navigator 
        services.
            ``(2) The term `health disparity population' means a 
        population that, as determined by the Secretary, has a 
        significant disparity in the overall rate of disease incidence, 
        prevalence, morbidity, mortality, or survival rates as compared 
        to the health status of the general population.
            ``(3) The term `patient navigator' means an individual who 
        has completed a training program approved by the Secretary to 
        perform the duties listed in subsection (b).
    ``(m) Authorization of Appropriations.--
            ``(1) In general.--To carry out this section, there are 
        authorized to be appropriated $2,000,000 for fiscal year 2006, 
        $5,000,000 for fiscal year 2007, $8,000,000 for fiscal year 
        2008, $6,500,000 for fiscal year 2009, and $3,500,000 for 
        fiscal year 2010.
            ``(2) Availability.--The amounts appropriated pursuant to 
        paragraph (1) shall remain available for obligation through the 
        end of fiscal year 2010.''.
                                                       Calendar No. 115

109th CONGRESS

  1st Session

                                 S. 898

                          [Report No. 109-73]

_______________________________________________________________________

                                 A BILL

  To amend the Public Health Service Act to authorize a demonstration 
grant program to provide patient navigator services to reduce barriers 
       and improve health care outcomes, and for other purposes.

_______________________________________________________________________

                              May 25, 2005

                       Reported with an amendment