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:

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 shall use evidence-based strategies and population-based public health approaches, including public education and outreach, professional training and development, quality assurance monitoring, surveillance, and evaluation, to increase quality colorectal cancer screening in the population aged 50 years and older, or for individuals under 50 who are at high risk. A program described in this subsection is a program for planning or implementing each of the following: (A)Providing evidence-based, recommended 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) to ensure the use of evidence-based recommended and quality screening and follow up in the prevention, 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 prevention, detection, and control of colorectal cancer and promoting the benefits of receiving screenings to populations recommended for screening. (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 $75,000,000 for each of fiscal years 2012 through 2016. (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).

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 (XXI), by striking or at the end; (B)in subclause (XXII), by adding or at the end; and (C)by adding at the end the following:

(XXIII)who are described in subsection (ll) (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:

(ll)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 2704(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 (XV) and inserting , (XV); (B)by striking setting and (XVI) and inserting setting, (XVII); and (C)by inserting , and (XVIII) the medical assistance made available to an individual described in subsection (ll) who is eligible for medical assistance only because of subparagraph (A)(10)(ii)(XXIII) 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 (xvi), by striking or at the end; (B)in clause (xvii), by adding or at the end; and (C)by inserting after clause (xvii) the following:

(xviii)individuals described in section 1902(ll),

(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 1920C the following:

1920D.

Optional application of presumptive eligibility provisions for certain persons with colorectal cancer

A State may elect to apply the provisions of section 1920B to individuals described in section 1902(ll) (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)), as amended by sections 2202(a) and 2303(b)(2) of Public Law 111–148, is amended— (i)in subparagraph (A), by inserting before the semicolon at the end the following: and provide for making medical assistance available to individuals described in section 1920D during a presumptive eligibility period in accordance with such section; and (ii)effective as of January 1, 2014, in subparagraph (B), by striking or 1920C and inserting 1920C, or 1920D. (B)Section 1903(u)(1)(D)(v) of such Act (42 U.S.C. 1396b(u)(1)(d)(v)) is amended by inserting , or for medical assistance provided to an individual described in section 1920D during a presumptive eligibility period under such section after 1920B 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)(XXIII). (d)

Effective date

The amendments made by this section apply to medical assistance for items and services furnished on or after October 1, 2011, without regard to whether final regulations to carry out such amendments have been promulgated by such date.