[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1189 Introduced in House (IH)]

111th CONGRESS
  1st Session
                                H. R. 1189

    To amend the Public Health Service Act to establish a national 
screening program at the Centers for Disease Control and Prevention and 
  to amend title XIX of the Social Security Act to provide States the 
  option to provide medical assistance for men and women screened and 
         found to have colorectal cancer or colorectal polyps.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           February 25, 2009

  Ms. Granger (for herself and Mr. Kennedy) 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 national 
screening program at the Centers for Disease Control and Prevention and 
  to amend title XIX of the Social Security Act to provide States the 
  option to provide medical assistance for men and women screened and 
         found to have colorectal cancer or colorectal polyps.

    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 Prevention, Early 
Detection, and Treatment Act of 2009''.

SEC. 2. PREVENTIVE HEALTH MEASURES WITH RESPECT TO COLORECTAL CANCER.

    Part B of title III of the Public Health Service Act (42 U.S.C. 243 
et seq.) is amended by inserting after section 317T the following new 
section:

``SEC. 317U. PREVENTIVE HEALTH MEASURES WITH RESPECT TO COLORECTAL 
              CANCER.

    ``(a) Grant Program Authorization.--
            ``(1) In general.--The Secretary, acting through the 
        Director of the Centers for Disease Control and Prevention, may 
        make grants to eligible entities for the purpose of carrying 
        out a program described in subsection (b). An eligible entity 
        that is a recipient of a grant under this subsection may use 
        such grant to carry out such programs directly or through 
        grants to, or contracts with, public and not-for-profit private 
        entities.
            ``(2) Eligible entity defined.--For purposes of this 
        section, the term `eligible entity' includes the following:
                    ``(A) A State, including, in addition to the 
                several States, the District of Columbia, Guam, the 
                Commonwealth of Puerto Rico, the Northern Mariana 
                Islands, the Virgin Islands, American Samoa, and the 
                Trust Territory of the Pacific Islands.
                    ``(B) An Indian tribe or tribal organization, as 
                such terms are defined in section 4 of the Indian Self-
                Determination and Education Assistance Act.
    ``(b) Programs Described.--
            ``(1) In general.--Subject to paragraph (2), a program 
        described in this subsection is a program for planning or 
        implementing each of the following:
                    ``(A) Providing screenings for colorectal cancer to 
                individuals who--
                            ``(i) are 50 years of age or older; or
                            ``(ii)(I) are under 50 years of age; and
                            ``(II) are at high risk for such cancer, as 
                        determined in accordance with subsection 
                        (e)(2).
                    ``(B) Providing appropriate case management and 
                referrals for medical treatment of individuals screened 
                pursuant to subparagraph (A).
                    ``(C) Ensuring (directly or through coordination or 
                an arrangement with health care providers or programs) 
                the full continuum of follow-up and cancer care for 
                individuals so screened, including appropriate follow-
                up for abnormal tests, diagnostic services, therapeutic 
                services, and treatment of detected cancers and 
                management of unanticipated medical complications.
                    ``(D) Carrying out activities to improve the 
                education, training, and skills of health professionals 
                (including allied health professionals) in the 
                detection and control of colorectal cancer, which 
                activities are carried out pursuant to the 
                participation of the health professionals in the 
                program.
                    ``(E) Establishing mechanisms through which the 
                eligible entity involved can monitor the quality of 
                screening and diagnostic follow-up procedures for 
                colorectal cancer, including the interpretation of such 
                procedures.
                    ``(F) Evaluating the activities described in this 
                subsection through appropriate surveillance and program 
                monitoring activities.
                    ``(G) Developing and disseminating findings derived 
                through such evaluations and the collection of data on 
                outcomes.
                    ``(H) Developing and disseminating public 
                information and education programs for the detection 
                and control of colorectal cancer and promoting the 
                benefits of receiving screenings through this program.
            ``(2) Supplement not supplant.--In the case of an eligible 
        entity that implements a universal colorectal screening program 
        under which the eligible entity makes available funds for 
        activities described in subparagraph (A), (B), or (C) of 
        paragraph (1), such entity shall be able to receive grant funds 
        under subsection (a) only for purposes of--
                    ``(A) carrying out those activities under this 
                subsection that are not so funded; or
                    ``(B) supplementing (and not supplanting) funds 
                made available by the entity for such funded program.
    ``(c) Priority for Low-Income, Uninsured and Underinsured 
Individuals.--A grant may be made under subsection (a) to an eligible 
entity only if the eligible entity agrees that, in providing screenings 
under subsection (b)(1)(A), the eligible entity will give priority to 
low-income individuals who lack adequate coverage, as determined by the 
Secretary, under health insurance and health plans with respect to 
screenings for colorectal cancer.
    ``(d) Special Consideration for Certain Applicants.--In making 
grants under subsection (a) for a fiscal year, the Secretary shall give 
special consideration to the following eligible entities:
            ``(1) In the case of services under such subsection for 
        women, to such entities that, for such year, are grantees under 
        title XV.
            ``(2) In the case of services under such subsection for 
        men, to such entities that, for such year, are grantees under 
        section 317D.
            ``(3) To such entities that coordinate with other Federal, 
        State, and local colorectal cancer programs.
            ``(4) To such entities with an existing program to provide 
        cancer screening to individuals.
    ``(e) Use of Certain Standards Under Medicare Program.--A grant may 
be made under subsection (a) to an eligible entity only if the eligible 
entity provides, as applicable, assurances as follows:
            ``(1) Screenings under subsection (b)(1)(A) will be carried 
        out as preventive health measures in accordance with evidence-
        based screening guidelines and procedures and in accordance 
        with the standard of care required for purposes of title XVIII 
        of the Social Security Act to carry out colorectal screening 
        tests defined in section 1861(pp)(1) of such Act.
            ``(2) An individual will be considered high risk for 
        purposes of subsection (b)(1)(A)(ii) only if the individual is 
        high risk within the meaning of section 1861(pp)(2) of such 
        Act.
            ``(3) The payment made from the grant for a screening 
        procedure under subsection (b)(1)(A) will not exceed the amount 
        that would be paid under part B of title XVIII of such Act if 
        payment were made under such part for furnishing the procedure 
        to an individual enrolled under such part.
    ``(f) Relationship to Items and Services Under Other Programs.--A 
grant under subsection (a) may be made to an eligible entity only if 
the eligible entity, as applicable, provides assurances 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.
    ``(g) Records and Audits.--A grant under subsection (a) may be made 
to an eligible entity only if the eligible entity provides assurances 
that the eligible entity will--
            ``(1) establish such fiscal control and fund accounting 
        procedures as may be necessary to ensure proper disbursal of, 
        and accounting for, amounts received under subsection (a); and
            ``(2) upon request, provide records maintained pursuant to 
        paragraph (1) to the Secretary or the Comptroller General of 
        the United States for purposes of auditing the expenditures of 
        the grant by the eligible entity.
    ``(h) Requirement of Matching Funds.--
            ``(1) In general.--The Secretary may not make a grant under 
        subsection (a) to an eligible entity for a fiscal year unless 
        the eligible entity agrees, with respect to the costs to be 
        incurred by the eligible entity for such fiscal year in 
        carrying out the activities described in subsection (b), to 
        make available non-Federal contributions (in cash or in kind 
        under paragraph (2)) toward such costs in an amount equal to 
        not less than $1 for each $3 of Federal funds provided in the 
        grant for such fiscal year. Such contributions may be made 
        directly or through donations from public or private entities.
            ``(2) Determination of amount of non-federal 
        contribution.--
                    ``(A) In general.--Non-Federal contributions 
                required in paragraph (1) 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) Maintenance of effort.--In making a 
                determination of the amount of non-Federal 
                contributions for purposes of paragraph (1), the 
                Secretary may include only non-Federal contributions in 
                excess of the average amount of non-Federal 
                contributions made by the eligible entity involved 
                toward the activities described in subsection (b) for 
                the 2-year period preceding the first fiscal year for 
                which the eligible entity is applying to receive a 
                grant under subsection (a).
                    ``(C) Inclusion of relevant non-federal 
                contributions for medicaid.--In making a determination 
                of the amount of non-Federal contributions for purposes 
                of paragraph (1), the Secretary shall, subject to 
                subparagraphs (A) and (B) of this paragraph, include 
                any non-Federal amounts expended pursuant to title XIX 
                of the Social Security Act by the eligible entity 
                involved toward the activities described in 
                subparagraphs (A) and (B) of subsection (b)(1).
    ``(i) Additional Requirements.--
            ``(1) Limitation on administrative expenses.--The Secretary 
        may not make a grant to an eligible entity under subsection (a) 
        unless the eligible entity provides assurances that not more 
        than 10 percent of the grant will be expended for 
        administrative expenses with respect to the activities funded 
        by the grant.
            ``(2) Statewide provision of services.--
                    ``(A) In general.--Subject to subparagraph (B), the 
                Secretary may not make a grant under subsection (a) to 
                an eligible entity unless the eligible entity provides 
                assurances that any program funded by such grant will 
                be made available throughout the State, including 
                availability to members of an Indian tribe or tribal 
                organization (as such terms are defined in section 4 of 
                the Indian Self-Determination and Education Assistance 
                Act).
                    ``(B) Waiver.--The Secretary may waive the 
                requirement under subparagraph (A) for an eligible 
                entity if the Secretary determines that compliance by 
                the eligible entity with the requirement would result 
                in an inefficient allocation of resources with respect 
                to carrying out the purposes described in subsection 
                (a).
    ``(j) Technical Assistance and Provision of Supplies and Services 
in Lieu of Grant Funds.--
            ``(1) Technical assistance.--The Secretary may provide 
        training and technical assistance with respect to the planning, 
        development, and operation of any program funded by a grant 
        under subsection (a). The Secretary may provide such technical 
        assistance directly to eligible entities or through grants to, 
        or contracts with, public and private entities.
            ``(2) Provision of supplies and services in lieu of grant 
        funds.--
                    ``(A) In general.--Subject to subparagraph (B), 
                upon the request of an eligible entity receiving a 
                grant under subsection (a), the Secretary for the 
                purpose of aiding the eligible entity to carry out a 
                program under subsection (b)--
                            ``(i) may provide supplies, equipment, and 
                        services to the eligible entity; and
                            ``(ii) may detail to the eligible entity 
                        any officer or employee of the Department of 
                        Health and Human Services.
                    ``(B) Corresponding reduction in payments.--With 
                respect to a request made by an eligible entity under 
                subparagraph (A), the Secretary shall reduce the amount 
                of payments made under the grant under subsection (a) 
                to the eligible entity by an amount equal to the fair 
                market value of any supplies, equipment, or services 
                provided by the Secretary and the costs of detailing 
                personnel (including pay, allowances, and travel 
                expenses) under subparagraph (A). The Secretary shall, 
                for the payment of expenses incurred in complying with 
                such request, expend the amounts withheld.
    ``(k) Reports.--A grant under subsection (a) may be made only if 
the applicant involved agrees to submit to the Secretary such reports 
as the Secretary may require with respect to the grant.
    ``(l) Authorization of Appropriations.--
            ``(1) In general.--For the purpose of carrying out this 
        section, there are authorized to be appropriated--
                    ``(A) for fiscal year 2009, $50,000,000;
                    ``(B) for fiscal year 2010, $75,000,000;
                    ``(C) for fiscal year 2011, $150,000,000;
                    ``(D) for fiscal year 2012, $200,000,000; and
                    ``(E) for fiscal year 2013, $250,000,000.
            ``(2) Set-aside for technical assistance and provision of 
        supplies and services.--Of the amount appropriated under 
        paragraph (1) for a fiscal year, the Secretary shall reserve 
        not to exceed 20 percent for carrying out subsection (j).''.

SEC. 3. OPTIONAL MEDICAID COVERAGE OF CERTAIN PERSONS SCREENED AND 
              FOUND TO HAVE COLORECTAL CANCER.

    (a) Coverage as Optional Categorically Needy Group.--
            (1) In general.--Section 1902(a)(10)(A)(ii) of the Social 
        Security Act (42 U.S.C. 1396a(a)(10)(A)(ii)) is amended--
                    (A) in subclause (XVIII), by striking ``or'' at the 
                end;
                    (B) in subclause (XIX), by adding ``or'' at the 
                end; and
                    (C) by adding at the end the following:
                                    ``(XX) who are described in 
                                subsection (dd) (relating to certain 
                                persons screened and found to need 
                                treatment from complications from 
                                screening or have colorectal 
                                cancer);''.
            (2) Group described.--Section 1902 of the Social Security 
        Act (42 U.S.C. 1396a) is amended by adding at the end the 
        following:
    ``(dd) Individuals described in this subsection are individuals 
who--
            ``(1) are not described in subsection (a)(10)(A)(i);
            ``(2) have not attained age 65;
            ``(3) have been screened for colorectal cancer and need 
        treatment for complications due to screening or colorectal 
        cancer; and
            ``(4) are not otherwise covered under creditable coverage, 
        as defined in section 2701(c) of the Public Health Service 
        Act.''.
            (3) Limitation on benefits.--Section 1902(a)(10) of the 
        Social Security Act (42 U.S.C. 1396a(a)(10)) is amended in the 
        matter following subparagraph (G)--
                    (A) by striking ``and (XIV)'' and inserting 
                ``(XIV)''; and
                    (B) by inserting ``, and (XV) the medical 
                assistance made available to an individual described in 
                subsection (dd) who is eligible for medical assistance 
                only because of subparagraph (A)(10)(ii)(XX) shall be 
                limited to medical assistance provided during the 
                period in which such an individual requires treatment 
                for complications due to screening or colorectal 
                cancer'' before the semicolon.
            (4) Conforming amendments.--Section 1905(a) of the Social 
        Security Act (42 U.S.C. 1396d(a)) is amended in the matter 
        preceding paragraph (1)--
                    (A) in clause (xii), by striking ``or'' at the end;
                    (B) in clause (xiii), by adding ``or'' at the end; 
                and
                    (C) by inserting after clause (xiii) the following:
                            ``(xiv) individuals described in section 
                        1902(dd),''.
    (b) Presumptive Eligibility.--
            (1) In general.--Title XIX of the Social Security Act (42 
        U.S.C. 1396 et seq.) is amended by inserting after section 
        1920B the following:

   ``optional application of presumptive eligibility provisions for 
                 certain persons with colorectal cancer

    ``Sec. 1920C.  A State may elect to apply the provisions of section 
1920B to individuals described in section 1902(dd) (relating to certain 
colorectal cancer patients) in the same manner as such section applies 
to individuals described in section 1902(aa) (relating to certain 
breast or cervical cancer patients).''.
            (2) Conforming amendments.--
                    (A) Section 1902(a)(47) of the Social Security Act 
                (42 U.S.C. 1396a(a)(47)) is amended--
                            (i) by striking ``and'' after ``section 
                        1920'' and inserting a comma;
                            (ii) by striking ``and'' after ``with such 
                        section'' and inserting a comma; and
                            (iii) by inserting before the semicolon at 
                        the end the following: ``, and provide for 
                        making medical assistance available to 
                        individuals described in section 1920C during a 
                        presumptive eligibility period in accordance 
                        with such section''.
                    (B) Section 1903(u)(1)(d)(v) of such Act (42 U.S.C. 
                1396b(u)(1)(d)(v)) is amended--
                            (i) by striking ``or for'' and inserting 
                        ``, for''; and
                            (ii) by inserting before the period the 
                        following: ``, or for medical assistance 
                        provided to an individual described in section 
                        1920C during a presumptive eligibility period 
                        under such section''.
    (c) Enhanced Match.--The first sentence of section 1905(b) of the 
Social Security Act (42 U.S.C. 1396d(b)) is amended--
            (1) by striking ``and'' before ``(4)''; and
            (2) by inserting before the period at the end the 
        following: ``, and (5) the Federal medical assistance 
        percentage shall be equal to the enhanced FMAP described in 
        section 2105(b) with respect to medical assistance provided to 
        individuals who are eligible for such assistance only on the 
        basis of section 1902(a)(10)(A)(ii)(XX)''.
    (d) Effective Date.--The amendments made by this section apply to 
medical assistance for items and services furnished on or after October 
1, 2009, without regard to whether final regulations to carry out such 
amendments have been promulgated by such date.
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