[Congressional Record Volume 145, Number 43 (Thursday, March 18, 1999)]
[Senate]
[Pages S2943-S2946]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. CHAFEE (for himself, Ms. Mikulski, Mr. Moynihan, Ms. 
        Snowe, Mr. Smith of Oregon, Mr. Harkin, Mr. Cochran, Mr. 
        Durbin, Mrs. Murray, Mr. Leahy, Mr. Rockefeller, Mr. Lieberman, 
        Mr. Lautenberg, Mrs. Feinstein, Mr. Bingaman, Mr. Sarbanes, Mr. 
        Hollings, Mr. Wellstone, Mr. Cleland, Mr. Kennedy, Mr. Johnson, 
        Mr. Robb, Mrs. Boxer, Mr. Reid, and Mr. Kerrey):
  S. 662. A bill to amend title XIX of the Social Security Act to 
provide medical assistance for certain women screened and found to have 
breast or cervical cancer under a federally funded screening program; 
to the Committee on Finance.


          the breast and cervical cancer treatment act of 1999

 Mr. CHAFEE. Mr. President, I am pleased today to introduce 
legislation that will provide life-saving treatment to women who have 
been diagnosed with breast and cervical cancer. I am very proud of this 
legislation and want to thank everyone who worked so hard to put this 
bill together.
  I want to take just a few minutes to explain what this legislation 
does. In

[[Page S2944]]

1990 Congress created a program, run by the Centers for Disease 
Control, to provide breast and cervical cancer screening for low-
income, uninsured women. This program is run in all 50 states and is 
tremendously successful. The CDC screens more than 500,000 women ever 
year, detecting more than 3,000 cases of breast cancer and 350 cases of 
cervical cancer.
  The problem comes about when these women try to get treatment for the 
cancer. They are uninsured, and are not eligible for either Medicaid or 
Medicare. They must rely on volunteers and charitable providers to find 
treatment services. Treatment for many is delayed, and many do not 
receive the crucial follow-up care. Some never receive treatment and 
others are left with huge medical bills they cannot pay.
  The legislation we are introducing today provides a simple solution 
to this problem. It gives states the option to provide those women, 
many of whom are mothers of young children, who are diagnosed with 
breast or cervical cancer under the CDC's screening program to obtain 
treatment through the medicaid program. The coverage would continue 
until the treatment and follow-up visits are completed.
  This is a modest, low-cost solution to a life or death problem. It 
costs less than $60 million per year to provide this critical 
treatment. I hope very much that we will be able to pass this bill this 
year.
  I ask that the legislation be printed in the Record.
  The bill follows:

                                 S. 662

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

     SECTION 1. OPTIONAL MEDICAID COVERAGE OF CERTAIN BREAST OR 
                   CERVICAL CANCER PATIENTS.

       (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 (XIII), by striking ``or'' at the end;
       (B) in subclause (XIV), by adding ``or'' at the end; and
       (C) by adding at the end the following:

       ``(XV) who are described in subsection (aa) (relating to 
     certain breast or cervical cancer patients);''.

       (2) Group described.--Section 1902 of the Social Security 
     Act (42 U.S.C. 1396a) is amended by adding at the end the 
     following:
       ``(aa) Individuals described in this paragraph are 
     individuals who--
       ``(1) are not described in subsection (a)(10)(A)(i);
       ``(2) have not attained age 65;
       ``(3) have been screened for breast and cervical cancer 
     under the Centers for Disease Control and Prevention breast 
     and cervical cancer early detection program established under 
     title XV of the Public Health Service Act (42 U.S.C. 300k et 
     seq.) in accordance with the requirements of section 1504 of 
     that Act (42 U.S.C. 300n) and need treatment for breast or 
     cervical cancer; and
       ``(4) are not otherwise covered under creditable coverage, 
     as defined in section 2701(c) of the Public Health Service 
     Act (45 U.S.C. 300gg(c)).''.
       (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 (F)--
       (A) by striking ``and (XIII)'' and inserting ``(XIII)''; 
     and
       (B) by inserting ``, and (XIV) the medical assistance made 
     available to an individual described in subsection (aa) who 
     is eligible for medical assistance only because of 
     subparagraph (A)(ii)(XV) shall be limited to medical 
     assistance provided during the period in which such an 
     individual requires treatment for breast or cervical 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 (x), by striking ``or'' at the end;
       (B) in clause (xi), by adding ``or'' at the end; and
       (C) by inserting after clause (xi) the following:
       ``(xii) individuals described in section 1902(aa),''.
       (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 
     1920A the following:


    ``presumptive eligibility for certain breast or cervical cancer 
                                patients

       ``Sec. 1920B. (a) State Option.--A State plan approved 
     under section 1902 may provide for making medical assistance 
     available to an individual described in section 1902(aa) 
     (relating to certain breast or cervical cancer patients) 
     during a presumptive eligibility period.
       ``(b) Definitions.--For purposes of this section:
       ``(1) Presumptive eligibility period.--The term 
     `presumptive eligibility period' means, with respect to an 
     individual described in subsection (a), the period that--
       ``(A) begins with the date on which a qualified entity 
     determines, on the basis of preliminary information, that the 
     individual is described in section 1902(aa); and
       ``(B) ends with (and includes) the earlier of--
       ``(i) the day on which a determination is made with respect 
     to the eligibility of such individual for services under the 
     State plan; or
       ``(ii) in the case of such an individual who does not file 
     an application by the last day of the month following the 
     month during which the entity makes the determination 
     referred to in subparagraph (A), such last day.
       ``(2) Qualified entity.--
       ``(A) In general.--Subject to subparagraph (B), the term 
     `qualified entity' means any entity that--
       ``(i) is eligible for payments under a State plan approved 
     under this title; and
       ``(ii) is determined by the State agency to be capable of 
     making determinations of the type described in paragraph 
     (1)(A).
       ``(B) Regulations.--The Secretary may issue regulations 
     further limiting those entities that may become qualified 
     entities in order to prevent fraud and abuse and for other 
     reasons.
       ``(C) Rule of construction.--Nothing in this paragraph 
     shall be construed as preventing a State from limiting the 
     classes of entities that may become qualified entities, 
     consistent with any limitations imposed under subparagraph 
     (B).
       ``(c) Administration.--
       ``(1) In general.--The State agency shall provide qualified 
     entities with--
       ``(A) such forms as are necessary for an application to be 
     made by an individual described in subsection (a) for medical 
     assistance under the State plan; and
       ``(B) information on how to assist such individuals in 
     completing and filing such forms.
       ``(2) Notification requirements.--A qualified entity that 
     determines under subsection (b)(1)(A) that an individual 
     described in subsection (a) is presumptively eligible for 
     medical assistance under a State plan shall--
       ``(A) notify the State agency of the determination within 5 
     working days after the date on which determination is made; 
     and
       ``(B) inform such individual at the time the determination 
     is made that an application for medical assistance under the 
     State plan is required to be made by not later than the last 
     day of the month following the month during which the 
     determination is made.
       ``(3) Application for medical assistance.--In the case of 
     an individual described in subsection (a) who is determined 
     by a qualified entity to be presumptively eligible for 
     medical assistance under a State plan, the individual shall 
     apply for medical assistance under such plan by not later 
     than the last day of the month following the month during 
     which the determination is made.
       ``(d) Payment.--Notwithstanding any other provision of this 
     title, medical assistance that--
       ``(1) is furnished to an individual described in subsection 
     (a)--
       ``(A) during a presumptive eligibility period;
       ``(B) by a entity that is eligible for payments under the 
     State plan; and
       ``(2) is included in the care and services covered by the 
     State plan;

     shall be treated as medical assistance provided by such plan 
     for purposes of section 1903(a)(5)(B).''.
       (2) Conforming amendments.--
       (A) Section 1902(a)(47) of the Social Security Act (42 
     U.S.C. 1396a(a)(47)) is amended by inserting before the 
     semicolon at the end the following: ``and provide for making 
     medical assistance available to individuals described in 
     subsection (a) of section 1920B 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 
     subsection (a) of section 1920B during a presumptive 
     eligibility period under such section''.
       (c) Enhanced Match.--Section 1903(a)(5) of the Social 
     Security Act (42 U.S.C. 1396b(a)(5)) is amended--
       (1) by striking ``an'' and inserting ``(A) an'';
       (2) by adding ``plus'' after the semicolon; and
       (3) by adding at the end the following:
       ``(B) an amount equal to 75 percent of the sums expended 
     during such quarter which are attributable to the offering, 
     arranging, and furnishing (directly or on a contract basis) 
     of medical assistance to an individual described in section 
     1902(aa); plus''.
       (d) Effective Date.--The amendments made by this section 
     apply to medical assistance furnished on or after October 1, 
     1999, without regard to whether final regulations to carry 
     out such amendments have been promulgated by such 
     date.

 Ms. MIKULSKI. Mr. President, I rise to join my distinguished 
colleagues Senators Chafee, Moynihan, Snowe, and to introduce 
legislation providing breast and cervical cancer treatment services to 
women who were diagnosed

[[Page S2945]]

with these cancers through the National Breast and Cervical Cancer 
Early Detection Program (NBCCEDP). This bill would give states the 
option to provide Medicaid coverage for the duration of breast and 
cervical cancer treatment to eligible women who were screened through 
the CDC program and found to have these cancers. This is a bill whose 
time has come.
  In 1990, I was proud to be the chief Senate sponsor of the Breast and 
Cervical Cancer Mortality Prevention Act which created the National 
Breast and Cervical Cancer Early Detection Program (NBCCEDP) at the 
CDC. The time was right for us to create that program. Since its 
inception, the CDC screening program has provided more than 721,000 
mammograms and 851,000 Pap tests to more than 1.2 million women. Among 
the women screened, over 3,600 cases of breast cancer and over 400 
cases of invasive cervical cancer have been diagnosed since the 
beginning of the program. In Maryland alone, the state had provided 
more than 54,000 mammograms and 35,000 Pap tests, and diagnosed over 
450 women with breast cancer and 15 women with invasive cervical 
cancer.
  Now as we prepare to enter the 21st century, it is time for us to 
finish what we started and provide treatment services for breast and 
cervical cancer for women who are screened through this program. We 
made the down payment in 1990 and we've been making payments ever 
since, but it's time for the final payment. It is time to do the right 
thing. We screen the women in this program for breast and cervical 
cancer. But we don't provide the federal follow-up to ensure that these 
women are treated.
  The CDC screening program does not pay for breast and cervical cancer 
treatment services, but it does require participating states to provide 
treatment services. A study of the program done for the Centers for 
Disease Control and Prevention found that while treatment was 
eventually found for almost all of the women screened, some women did 
not get treated at all, some refused treatment, and some experienced 
delays. While states and localities have been diligent and creative in 
finding treatment services for these women, the reality is that the 
system is overloaded. The CDC study found that when it came to 
treatment services, state efforts to obtain these services were short-
term, labor-intensive solutions that diverted resources away from 
screening activities.
  Of those women diagnosed with cancer in the United States, nearly 
3,000 women have no way to afford treatment--they have no health care 
insurance coverage or are underinsured. One woman in Massachusetts 
reported that she cashed in her life insurance policy to cover the 
costs of her treatment. These women depend on the time of staff and 
volunteers who help them find free or more affordable treatment; they 
depend on the generosity of doctors, nurses, hospitals and clinics who 
provide them with free or reduced-cost treatment. In the end, thousands 
of women who run local screening programs are spending countless hours 
finding treatment services for women diagnosed with breast cancer. I 
salute the efforts of these individuals who spend their time and 
resources to help these women.
  But we must not force these women to rely on the goodwill of others. 
These treatment efforts will become even more difficult as more women 
are screened by the NBCCEDP, which currently services only 12-15% of 
all women who are eligible nationally. The lack of coverage for 
diagnostic and treatment services has also had a very negative impact 
on the program's ability to recruit providers, further restricting the 
number of women screened. The CDC study also shows there are already 
additional stresses on the program as increasing numbers of physicians 
do not have the autonomy in today's ever increasing managed care system 
to offer free or reduced-fee services. While CDC has expanded its case 
management services to help more women get treatment, even CDC admits 
that ``more formalized and sustained mechanisms need to be instituted 
to ensure that all women screened have ready access to appropriate 
treatment and follow-up.'' It is an outrage that women with cancer must 
go begging for treatment, especially if the federal government has held 
out the promise of early detection. We should follow through on our 
responsibility to treat the cancer that these women were diagnosed with 
through the CDC program.
  That's why I've introduced this important legislation with my 
colleagues. This bill gives states the option to provide Medicaid 
coverage for the duration of breast and cervical cancer treatment to 
eligible women who were screened through the CDC program and found to 
have these cancers. This is not a mandate for states; it is the federal 
government saying to the states ``we will help you provide treatment 
services to these women, if you decide to do so.'' By choosing this 
option, states would in effect, extend the federal-state partnership 
that exists for the screening services in the CDC program to treatment 
services.
  I'm proud that my own state of Maryland realized the importance of 
providing treatment services to women who were screened through the CDC 
screening program. Maryland appropriated over $6 million in state funds 
to establish a Breast and Cervical Cancer Diagnostic and Treatment 
Program for uninsured, low income women. The breast cancer mortality 
rate in Maryland has started to decline, in part because of programs 
like the CDC program. But not all states have the resources to do what 
Maryland has done. That's why this bill is needed. It provides a long-
term solution. Screening alone does not prevent cancer deaths; but 
treatment can. It's a cruel and heart-breaking irony for the federal 
government to promise to screen low-income women for breast and 
cervical cancer, but not to establish a program to treat those women 
who have been diagnosed with cancer through a federal program.
  It is clear that the short-term, ad-hoc strategies of providing 
treatment have broken down: for the women who are screened; for the 
local programs that fund the screening program; and for the states that 
face increasing burdens. Because there is not coverage for treatment, 
state programs are having a hard time recruiting providers, volunteers 
are spending a disproportionate amount of time finding treatment for 
women, and fewer women are receiving treatment. We can't grow the 
program to serve the other 78% of eligible women if we can't promise 
treatment to those we already screen.
  This bill is the best long-term solution. It is strongly supported by 
the National Breast Cancer Coalition representing over 400 
organizations and 100,000's of women across the nation; the American 
Cancer Society, the National Association of Public Hospitals and Health 
Systems, the National Partnership for Women and Families, YWCA, 
National Women's Health Network, Oncology Nursing Society, Association 
of Women's Health, Obstetric, and Neonatal Nurses, the Rhode Island 
Breast Cancer Coalition, Y-ME, and Arm in Arm. I urge my colleagues to 
cosponsor and support this critical piece of legislation and make good 
on the promise of early detection.
 Mr. MOYNIHAN. Mr. President, today, I join with my colleagues 
Senators Chafee, Mikulski, and Snowe in introducing legislation to 
ensure that women with breast or cervical cancer will receive coverage 
for their treatment. The Federal Centers for Disease Control and 
Prevention (CDC) has a successful nationwide program--National Breast 
and Cervical Cancer Early Detection program--that provides funding for 
states to screen low-income uninsured women for breast and cervical 
cancer. However, the CDC program is not designed and does not have 
funding to treat these women after they are diagnosed.
  The women eligible for cancer screening under the CDC program are 
low-income individuals, yet are not poor enough to qualify for Medicaid 
coverage. They do not have health insurance coverage for these 
screenings and for subsequent cancer treatment.
  From July of 1991 to September of 1997, the CDC program provided 
mammography screening to 722,000 women and diagnosed 3,600 cases of 
breast cancer. During this same period, the program also provided over 
852,000 pap smears and found more than 400 cases of invasive cervical 
cancer.
  The CDC screening program has had to divert a significant amount of 
its resources from screenings in order to find treatment for the women 
found to have

[[Page S2946]]

breast and cervical cancer. The lack of subsequent funding for 
treatment has, therefore, jeopardized the programs' primary function: 
to screen low-income uninsured women for breast and cervical cancer. 
Currently, the program screens only about 12 to 15 percent of all 
eligible women.
  A study conducted at Battelle Centers for Public Health Research and 
Evaluation and the University of Michigan School of Public Health on 
treatment funding for women screened by the CDC program found that, 
although funding for treatment services were found for most of these 
women, treatment was not always available when needed. In addition, 
during the search for treatment funding, the CDC program lost contact 
with several women. The study also found that the sources of treatment 
funding are uncertain, tenuous and fragmented. The burden of funding 
treatment often fell upon providers themselves. Seeking charity care 
from public hospitals adds to hospitals' uncompensated care costs. It 
is no surprise that the National Association of Public Hospitals 
supports our bill to provide coverage for these women.
  The legislation would allow states to provide treatment coverage for 
low-income women who are screened and diagnosed through the CDC program 
and who are uninsured. States will have the option to provide this 
coverage through its Medicaid program. States choosing this option 
would receive an enhanced match for the treatment coverage, similar to 
the federal match provided to the state for the CDC screening program. 
With this legislation, the Federal Government will follow through on 
its intent to assist low-income women with breast and cervical cancer.
  Mr. President, the Senate has approved this proposal in the past. A 
similar provision was included in the Senate version of the Balanced 
Budget bill. I urge the Senate to again support this important 
legislation.
                                 ______