[Congressional Record Volume 150, Number 103 (Thursday, July 22, 2004)]
[Senate]
[Pages S8760-S8767]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. FRIST (for himself and Mr. Kennedy):
  S. 2771. A bill to amend the Public Health Service Act to improve the 
quality of care for cancer, and for other purposes; to the Committee on 
Health, Education, Labor, and Pensions.
  Mr. FRIST. Mr. President, I ask unanimous consent that the text of 
the bill be printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 2771

       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 ``Quality of Care for 
     Individuals With Cancer Act''.

     SEC. 2. TABLE OF CONTENTS.

Sec. 1. Short title.
Sec. 2. Table of contents.

             TITLE I--MEASURING THE QUALITY OF CANCER CARE

Sec. 101. Development of core sets of quality of cancer care measures.

                  TITLE II--ENHANCING DATA COLLECTION

Sec. 201. Expansion of national program of cancer registries.
Sec. 202. Reauthorization of national program of cancer registries.
Sec. 203. Relationship to certification.

    TITLE III--MONITORING AND EVALUATING QUALITY OF CANCER CARE AND 
                                OUTCOMES

Sec. 301. Partnerships to develop model systems for monitoring and 
              evaluating quality of cancer care and outcomes.

          TITLE IV--STRENGTHENING COMPREHENSIVE CANCER CONTROL

Sec. 401. Comprehensive cancer control program.

[[Page S8761]]

         TITLE V--IMPROVING NAVIGATION AND SYSTEM COORDINATION

Sec. 501. Enhancing cancer care through improved navigation.
Sec. 502. Cancer care coordination.

           TITLE VI--ESTABLISHING PROGRAMS IN PALLIATIVE CARE

Sec. 601. Programs to improve palliative care.

             TITLE VII--ESTABLISHING SURVIVORSHIP PROGRAMS

Sec. 701. Programs for survivorship.
Sec. 702. Cancer control programs.

               TITLE VIII--PROGRAMS FOR END-OF-LIFE CARE

Sec. 801. Programs for end-of-life care.

                TITLE IX--DEVELOPING TRAINING CURRICULA

Sec. 901. Curriculum development.
Sec. 902. Cancer care workforce and translational research.

                  TITLE X--BREAST AND CERVICAL CANCER

Sec. 1001. Waivers relating to grants for preventive health measures 
              with respect to breast and cervical cancers.

                      TITLE XI--COLORECTAL CANCER

Sec. 1101. Programs to improve colorectal cancer screening.

                     TITLE XII--CONDUCTING REPORTS

Sec. 1201. Studies and reports by the Institute of Medicine.

             TITLE I--MEASURING THE QUALITY OF CANCER CARE

     SEC. 101. DEVELOPMENT OF CORE SETS OF QUALITY OF CANCER CARE 
                   MEASURES.

       (a) Development of Core Sets of Quality of Cancer Care 
     Measures.--Subpart 1 of part C of title IV of the Public 
     Health Service Act (42 U.S.C. 285 et seq.) is amended by 
     adding at the end the following:

     ``SEC. 417E. DEVELOPMENT OF CORE SETS OF QUALITY OF CANCER 
                   CARE MEASURES.

       ``(a) In General.--The Secretary shall award a contract to 
     a national voluntary consensus organization to identify core 
     sets of quality of cancer care measures.
       ``(b) Quality of Cancer Care Measures.--An entity that 
     receives a contract under this section shall identify core 
     sets of quality of cancer care measures in consultation with 
     a panel or advisory group of interested parties, including 
     significant participation from consumer representatives 
     (which shall include survivors of cancer and their families 
     and members of organizations representing such survivors and 
     their families), health care providers, cancer researchers, 
     payers and purchasers of cancer care services and insurance, 
     and public and private organizations that monitor, accredit, 
     or seek to improve the quality of cancer care.
       ``(c) Report by Entity.--Not later than 24 months after the 
     date of enactment of this section, an eligible entity that 
     receives a contract under this section shall submit to the 
     Secretary a report that--
       ``(1) lists existing measures used to assess and improve 
     the quality of cancer care;
       ``(2) identifies those measures that have been 
     scientifically validated, those measures that still require 
     validation, and those aspects of cancer care for which 
     additional measures need to be developed or validated;
       ``(3) recommends a core set of validated quality of cancer 
     care measures, reflecting a voluntary consensus of interested 
     parties, for measuring and improving the quality of cancer 
     care;
       ``(4) summarizes the process used to develop the consensus 
     recommendations in paragraph (3), including a statement of 
     any minority views; and
       ``(5) develops a process for updating the core sets of 
     validated quality of cancer care measures as new scientific 
     evidence becomes available.
       ``(d) Recommendations by Secretary.--Not later than 6 
     months after the date the Secretary receives the report 
     described in subsection (c), the Secretary shall issue 
     recommendations on the areas described in paragraphs (1) 
     through (5) of such subsection and shall transmit such 
     recommendations to the President.
       ``(e) Report by President.--Not later than 6 months after 
     receipt of the report described in subsection (d), the 
     President shall, in consultation with the Quality Interagency 
     Coordination Task Force (established by a Presidential 
     Directive in 1998)--
       ``(1) provide to the appropriate committees of Congress a 
     report that describes a plan to use the core sets of quality 
     of cancer care measures in programs administered by the 
     Federal Government, including outlining activities to support 
     the widespread dissemination of the report, and provide any 
     other recommendations the President determines to be 
     appropriate; and
       ``(2) provide updated reports, in accordance with 
     subsection (c)(5), if new quality measures or scientific 
     evidence on quality of cancer care develops.
       ``(f) Technical Support.--The Secretary may provide 
     scientific and technical support to ensure that the 
     scientific evaluation requirements in this section are met.
       ``(g) AHRQ.--
       ``(1) Annual report.--The Agency for Healthcare Research 
     and Quality shall include in the annual report required under 
     section 913(b)(2) the core set of quality of cancer care 
     measures developed under this section that are suitable for 
     quality monitoring.
       ``(2) Requirement.--The Secretary shall ensure that all 
     agencies within the Department of Health and Human Services 
     shall provide the information necessary for the report 
     described in paragraph (1) regarding quality of cancer care 
     measures.
       ``(h) Support.--The Director of the Agency for Healthcare 
     Research and Quality, acting in collaboration with the 
     Director of the National Cancer Institute and the Director of 
     the Centers for Disease Control and Prevention, shall support 
     the development and validation of measures identified by the 
     report in subsection (d).
       ``(i) Definitions of Hospice Care; Palliative Care; Quality 
     of Cancer Care; Health Disparity Populations; Health 
     Disparities Research.--In this section the terms `hospice 
     care', `palliative care', `quality of cancer care', `health 
     disparity populations', and `minority health disparities 
     research' have the meanings given such terms in section 
     399AA.
       ``(j) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, such sums as 
     may be necessary for each of fiscal years 2006 through 
     2010.''.
       (b) Monitoring.--Not later than 4 years after the date of 
     the transmission of the report required under section 417E(e) 
     of the Public Health Service Act, the Comptroller of the 
     General Accounting Office shall submit to the appropriate 
     committees of Congress a report that evaluates the extent to 
     which Federal and private sector health care delivery 
     programs, States, and State cancer plans are utilizing the 
     core sets of quality of cancer care measures (developed under 
     section 417E of the Public Health Service Act) and the extent 
     to which its adoption is affecting the quality of cancer 
     care.

                  TITLE II--ENHANCING DATA COLLECTION

     SEC. 201. EXPANSION OF NATIONAL PROGRAM OF CANCER REGISTRIES.

       Part M of title III of the Public Health Service Act (42 
     U.S.C. 280e et seq.) is amended by inserting after section 
     399E, the following:

     ``SEC. 399E-1. MONITORING AND EVALUATING THE QUALITY OF 
                   CANCER CARE.

       ``(a) Demonstration Projects.--The Secretary, acting 
     through the Director of the Centers for Disease Control and 
     Prevention, and in coordination with the Director of the 
     National Cancer Institute, shall award competitive grants to 
     State cancer registries that receive funds under this part to 
     enable such registries to expand their ability to monitor and 
     evaluate the quality of cancer care, to develop information 
     concerning the quality of cancer care, and to monitor cancer 
     survivorship.
       ``(b) Eligibility.--To be eligible to receive a grant under 
     subsection (a), a State cancer registry shall be certified by 
     the North American Association of Central Cancer Registries 
     or other similar certification organization.
       ``(c) Application.--A State cancer registry desiring a 
     grant under this section shall submit an application to the 
     Secretary at such time, in such manner, and containing such 
     information as the Secretary may require.
       ``(d) Contracting Authority.--A State cancer registry 
     receiving a grant under this section may enter into contracts 
     with academic institutions, cancer centers, and other 
     entities determined to be appropriate by the Secretary, to 
     carry out the activities authorized under this section.
       ``(e) Use of Funds.--A State cancer registry receiving a 
     grant under this section shall use amounts received under 
     such grant to--
       ``(1) collect information for public health surveillance 
     and quality improvement activities using the quality of 
     cancer care measures developed under section 417E (where 
     appropriate), including data concerning racial, ethnic, and 
     other health disparity populations within the State that may 
     have a disparity in incidence or survival from cancer;
       ``(2) develop linkages between State cancer registry data 
     and other databases, including those that collect outpatient 
     data, to gather information concerning the quality of cancer 
     care;
       ``(3) identify, develop, and disseminate evidence-based 
     best practices relating to cancer care regarding how States 
     use registry data and how to better link and coordinate the 
     sharing of such data;
       ``(4) identify geographic areas and populations within the 
     State that have an increased need for awareness regarding 
     cancer risk reduction, screening, prevention, and treatment 
     activities;
       ``(5) increase coordination between State cancer registries 
     and other entities, including academic institutions, 
     hospitals, health centers, researchers, health care 
     providers, cancer centers, or nonprofit organizations;
       ``(6) incorporate the collection of data on cancer 
     survivors for the purpose of improving the quality of cancer 
     care;
       ``(7) identify the impact of co-morbidity of other diseases 
     on survival from cancer; or
       ``(8) develop methods of determining whether cancer 
     survivors are at an increased risk for other chronic or 
     disabling conditions.
       ``(f) Privacy.--A State cancer registry receiving a grant 
     or an entity receiving a contract under this section shall 
     comply with appropriate security and privacy protocols 
     (including protocols required under the regulations  
     promulgated under section 264(c) of

[[Page S8762]]

     the Health Insurance Portability and Accountability Act of 
     1996 (42 U.S.C. 1320d-2 note)), if applicable, with 
     respect to information collected under this title. Nothing 
     in this section shall be construed to supersede applicable 
     Federal or State privacy laws.
       ``(g) Databases.--
       ``(1) In general.--In carrying out this section, a State 
     cancer registry may utilize appropriate databases, 
     including--
       ``(A) the National Death Index;
       ``(B) databases related to claims under the medicare and 
     medicaid programs under titles XVIII and XIX of the Social 
     Security Act; and
       ``(C) other databases maintained by the Department of 
     Health and Human Services (including those maintained at the 
     Agency for Healthcare Research and Quality, the Centers for 
     Disease Control and Prevention, the Centers for Medicare & 
     Medicaid Services, and the National Institutes of Health).
       ``(2) Additional data.--A State cancer registry may utilize 
     data in addition to the databases described in paragraph (1), 
     including data maintained by private insurance plans and 
     health care delivery organizations.
       ``(h) Rule of Construction.--Nothing in this section shall 
     be construed to require an individual or entity to submit 
     information to a State cancer registry under this section.
       ``(i) Definitions.--In this section:
       ``(1) Health center.--The term `health center' has the 
     meaning given the term `federally qualified health center' in 
     section 1861(aa)(4) of the Social Security Act (12 U.S.C. 
     1395x(aa)(4)).
       ``(2) Quality of cancer care.--The term `quality of cancer 
     care' has the meaning given such term in section 399AA.
       ``(j) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, such sums as 
     may be necessary for each of fiscal years 2006 through 2010.

     ``SEC. 399E-2. CANCER SURVEILLANCE SYSTEM.

       ``(a) In General.--The Secretary, acting through the 
     Director of the Centers for Disease Control and Prevention, 
     and in coordination with the Director of the National Cancer 
     Institute, shall--
       ``(1) establish the Cancer Surveillance System (referred to 
     in this section as the `System') to monitor State cancer 
     registries funded under section 399B; and
       ``(2) provide for the development, expansion, and 
     evaluation of such registries.
       ``(b) Duties.--The System shall--
       ``(1) facilitate timely access to and exchange of accurate 
     quality of cancer care information among State cancer 
     registries including the use of the quality of cancer care 
     measures developed under section 417E, where appropriate;
       ``(2) develop guidelines permitting State cancer registries 
     to access the national registry clearinghouse established 
     under paragraph (3);
       ``(3) establish and maintain a registry information 
     clearinghouse to collect, synthesize, and disseminate 
     information concerning evidence-based best practices for the 
     creative use of State cancer registries, including 
     maintaining an Internet website where such information may be 
     accessed;
       ``(4) determine the feasibility of monitoring the quality 
     of palliative care by State cancer registries;
       ``(5) identify and develop evidence-based best practices 
     for coordination between cancer registries and other 
     entities;
       ``(6) update information collected or made available under 
     this section as determined to be necessary by the Secretary; 
     and
       ``(7)(A) review pediatric cancer data collected by State 
     cancer registries and evaluate--
       ``(i) such data for adequacy, completeness, timeliness, and 
     quality; and
       ``(ii) current efforts to aggregate and disseminate such 
     data; and
       ``(B) not later than January 1, 2006, submit to Congress a 
     report on the findings made under subparagraph (A).
       ``(c) Privacy.--The System shall comply with appropriate 
     security and privacy protocols (including protocols required 
     under the regulations promulgated under section 264(c) of the 
     Health Insurance Portability and Accountability Act of 1996 
     (42 U.S.C. 1320d-2 note)), if applicable, with respect to 
     information collected by the System. Nothing in this section 
     shall be construed to supersede applicable Federal or State 
     privacy laws.
       ``(d) Definitions.--In this section, the terms `palliative 
     care' and `quality of cancer care' have the meanings given 
     such terms in section 399AA.
       ``(e) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, such sums as 
     may be necessary for each of fiscal years 2006 through 
     2010.''.

     SEC. 202. REAUTHORIZATION OF NATIONAL PROGRAM OF CANCER 
                   REGISTRIES.

       Section 399F(a) of the Public Health Service Act (42 U.S.C. 
     280e-4(a)) is amended--
       (1) by striking ``this part,'' and inserting ``this part, 
     other than sections 399E-1 and 399E-2),''; and
       (2) by striking ``2003'' and inserting ``2010''.

     SEC. 203. MATCHING FUNDS; RELATIONSHIP TO CERTIFICATION.

       (a) Matching Funds.--Section 399B(b)(1) of the Public 
     Health Service Act (42 U.S.C. 280e(B)(1)) is amended by 
     striking ``$3'' and inserting ``$5''.
       (b) Relationship to Certification.--Section 399E of the 
     Public Health Service Act (42 U.S.C. 280e-3) is amended--
       (1) by redesignating subsections (d) and (e) as subsections 
     (e) and (f), respectively; and
       (2) by inserting after subsection (c) the following:
       ``(d) Relationship to Certification.--The Centers for 
     Disease Control and Prevention is encouraged to work with 
     eligible entities through the provision of technical 
     assistance and funding authority under the National Program 
     of Cancer Registries to assist such entities in complying 
     with the certification process of the North American 
     Association of Central Cancer Registries or similar 
     certification organization.''.

    TITLE III--MONITORING AND EVALUATING QUALITY OF CANCER CARE AND 
                                OUTCOMES

     SEC. 301. PARTNERSHIPS TO DEVELOP MODEL SYSTEMS FOR 
                   MONITORING AND EVALUATING QUALITY OF CANCER 
                   CARE AND OUTCOMES.

       (a) Quality of Cancer Care.--Part A of title IX of the 
     Public Health Service Act (42 U.S.C. 299 et seq.) is amended 
     by adding at the end the following:

     ``SEC. 904. AREAS OF SPECIAL EMPHASIS.

       ``(a) Quality of Cancer Care.--The Secretary, acting 
     through the Director and in collaboration with the Director 
     of the Centers for Disease Control and Prevention and the 
     Director of the National Cancer Institute, shall conduct and 
     support research pertaining to the measurement, evaluation, 
     and improvement of the quality of cancer care, take steps to 
     enhance the usefulness of such research to improve patient 
     care, and appropriately disseminate such information by--
       ``(1) expanding the evidence base concerning effective 
     interventions for improving the quality of cancer care;
       ``(2) ensuring effective analysis of data collected by 
     State cancer registries funded under section 399B by 
     developing evidence-based best practices for--
       ``(A) the real-time recording of and automated transfer of 
     cancer care data to State cancer care registries; and
       ``(B) the linkage of registry data with private sector 
     claims data and other existing data systems for purposes of 
     analytic academic research;
       ``(3) developing and validating quality of cancer care 
     indicators and evaluate their use and usefulness; and
       ``(4) developing volume-based quality indicators, as 
     appropriate, and evaluate ongoing efforts to integrate 
     volume-based measures into cancer quality improvement 
     programs and their impact on patient decisionmaking.
       ``(b) Partnerships To Speed the Pace of Improvements in the 
     Quality of Cancer Care.--
       ``(1) In general.--The Secretary, acting through the 
     Director and in collaboration with the Director of the 
     Centers for Disease Control and Prevention and the Director 
     of the National Cancer Institute, shall award competitive 
     grants, contracts, or enter into cooperative agreements with 
     eligible entities to--
       ``(A) foster the development or adoption of model systems 
     of cancer care;
       ``(B) speed the pace of improvement in the quality of 
     cancer care; or
       ``(C) when appropriate, carry out the other requirements of 
     this section.
       ``(2) Eligibility.--In accordance with the limitations of 
     section 926(c), an applicant eligible to receive a grant, 
     contract, or cooperative agreement under this subsection 
     shall be a consortium consisting of public- and private-
     sector entities. Each consortium shall include an institution 
     of higher learning or other research entity and 1 or more of 
     the following:
       ``(A) An entity that delivers or purchases cancer care.
       ``(B) A professional society or societies that represent 
     health care providers and other cancer caregivers, including 
     hospice programs.
       ``(C) A consumer or patient organization.
       ``(D) An entity involved in the monitoring of quality of 
     cancer care or efforts to improve cancer care (including a 
     State or local health department).
       ``(d) Collaboration.--In carrying out this section, the 
     Secretary, acting through the Director, shall ensure 
     coordination with appropriate Federal and State agencies, 
     private quality improvement entities, and accreditation or 
     licensure organizations with an interest in improving the 
     quality of cancer care.
       ``(e) Definitions.--In this section, the term `quality of 
     cancer care' has the meaning given such term in section 
     399AA.''.
       (b) Authorization of Appropriations.--Section 927 of the 
     Public Health Service Act (42 U.S.C. 299c-6) is amended by 
     adding at the end the following:
       ``(e) Quality of Cancer Care.--For the purpose of carrying 
     out the activities under section 904, such sums as may be 
     necessary for each of fiscal years 2005 through 2010.''.

          TITLE IV--STRENGTHENING COMPREHENSIVE CANCER CONTROL

     SEC. 401. COMPREHENSIVE CANCER CONTROL PROGRAM.

       Part B of title III of the Public Health Service Act (42 
     U.S.C. 243 et seq.) is amended by adding at the end the 
     following:

     ``SEC. 320B. COMPREHENSIVE CANCER CONTROL PROGRAM.

       ``(a) Establishment.--The Secretary, acting through the 
     Director of the Centers for Disease Control and Prevention 
     and in consultation with the Director of the Agency for 
     Healthcare Research and Quality and the Director of the 
     National Cancer Institute, shall establish a National 
     Comprehensive Cancer

[[Page S8763]]

     Control Program (referred to in this section as the 
     `Program') to improve the quality of cancer care.
       ``(b) Program.--In carrying out the Program the Secretary 
     shall--
       ``(1) establish guidelines regarding the design and 
     implementation of comprehensive cancer control plans; and
       ``(2) award competitive grants to eligible entities to 
     develop, update, implement, and evaluate comprehensive cancer 
     control plans.
       ``(c) Eligibility.--An entity is eligible to receive 
     assistance under the Program if such entity is a State health 
     department, territory, Indian tribe, or tribal organization 
     or its designee.
       ``(d) Application.--An eligible entity desiring a grant 
     under this section shall submit an application to the 
     Secretary at such time, in such manner, and containing such 
     information as the Secretary may require, including--
       ``(1) a description of how assistance under such grant will 
     be used to develop and implement comprehensive cancer control 
     programs, including programs to monitor the quality of cancer 
     care (which may include the use of quality of cancer care 
     measures developed under section 417E);
       ``(2) a description of how the applicant will integrate its 
     activities with academic institutions, nonprofit 
     organizations, or other appropriate entities in planning and 
     implementing comprehensive cancer control plans; and
       ``(3) a description of how activities carried out by the 
     applicant will be evaluated.
       ``(e) Use of Funds.--An entity shall use assistance 
     received under this section to--
       ``(1) convene stakeholders, including stakeholders from the 
     public, private, and nonprofit sectors, to determine 
     priorities for the State, territory, or tribe involved;
       ``(2) develop, update, implement, or evaluate comprehensive 
     cancer control plans;
       ``(3) assess disparities in cancer risk reduction, 
     prevention, diagnosis, or quality of cancer care; and
       ``(4) develop and disseminate best practices, where 
     appropriate, and evaluate the application of such practices 
     as necessary.
       ``(f) Definitions.--In this section:
       ``(1) Comprehensive cancer control plan.--The term 
     `comprehensive cancer control plan' means a plan developed 
     with assistance provided under this section that provides for 
     an integrated and coordinated approach to reducing the 
     incidence, morbidity, and mortality of cancer, with a 
     particular emphasis on preventing and controlling cancer 
     among populations most at risk and reducing cancer 
     disparities among underserved populations.
       ``(2) Comprehensive cancer control program.--The term 
     `comprehensive cancer control program' means a program to 
     fulfill the comprehensive control plan.
       ``(3) Quality of cancer care.--The term `quality of cancer 
     care' has the meaning given such term in section 399AA.
       ``(4) Indian tribe; tribal organization.--The terms `Indian 
     tribe' and `tribal organization' have the meanings given such 
     terms in subsections (b) and (c) of section 4 of the Indian 
     Self-Determination and Education Assistance Act (25 U.S.C. 
     450b).
       ``(g) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, such sums as 
     may be necessary for each of fiscal years 2006 through 
     2010.''.

         TITLE V--IMPROVING NAVIGATION AND SYSTEM COORDINATION

     SEC. 501. ENHANCING CANCER CARE THROUGH IMPROVED NAVIGATION 
                   AND CANCER CARE COORDINATION.

       Title III of the Public Health Service Act (42 U.S.C. 241 
     et seq.) is amended by adding at the end the following:

               ``Part R--Cancer Prevention and Treatment

     ``SEC. 399AA. DEFINITIONS; AUTHORIZATION OF APPROPRIATIONS.

       ``(a) Definitions.--In this part:
       ``(1) Culturally competent.--The term `culturally 
     competent', with respect to the manner in which health-
     related services, education, and training are provided, means 
     providing the services, education, and training in the 
     language and cultural context that is most appropriate for 
     the individuals for whom the services, education, and 
     training are intended.
       ``(2) Health center.--The term `health center' has the 
     meaning given such term in section 399E-1.
       ``(3) Health disparity population.--The term `health 
     disparity population' has the meaning given such term in 
     section 903(d)(1).
       ``(4) Health disparities research.--The term `health 
     disparities research' means basic, clinical, and behavioral 
     research on health conditions disproportionately affecting 
     individuals from health disparity populations, including 
     research to prevent, diagnose, and treat such conditions. 
     Such health conditions shall include all diseases, disorders, 
     and conditions affecting individuals from health disparity 
     populations that are--
       ``(A) unique to, more serious, or more prevalent in such 
     individuals;
       ``(B) for which the factors of medical risk or types of 
     medical intervention may be different for such individuals, 
     or for which it is unknown whether such factors or types are 
     different for such individuals; or
       ``(C) with respect to which there has been insufficient 
     research involving such individuals as subjects or 
     insufficient data on such individuals.
       ``(5) Hospice care.--The term `hospice care' has the 
     meaning given such term in section 1861(dd)(1) of the Social 
     Security Act (42 U.S.C. 1395x(dd)(1)).
       ``(6) Hospice program.--The term `hospice program' has the 
     meaning given such term in section 1861(dd)(2) of the Social 
     Security Act (42 U.S.C. 1395x(dd)(2)).
       ``(7) Palliative care.--The term `palliative care' means 
     comprehensive, interdisciplinary, coordinated, and 
     appropriate care and services provided throughout all stages 
     of disease, from the time of diagnosis to the end of life, 
     relating to pain and other symptom management, including 
     psychosocial needs, that seeks to improve quality of life and 
     prevent and alleviate suffering for an individual and, if 
     appropriate, that individual's family or caregivers.
       ``(8) Quality of cancer care.--The term `quality of cancer 
     care' means the provision of cancer-related, timely, 
     evidence-based (whenever there is scientific evidence on the 
     effectiveness of interventions), patient-centered care and 
     services of individuals in a technically and culturally 
     competent and appropriate manner, using effective 
     communication and shared decisionmaking to improve clinical 
     outcomes, survival, or quality of life which encompasses--
       ``(A) the various stages of care, including care and 
     services provided to individuals with a family history of 
     cancer, with an abnormal cancer screening test, or who are 
     clinically diagnosed with cancer, beginning with risk 
     reduction, prevention, and early detection through 
     survivorship, remission, and end-of-life care, and including 
     risk counseling, screening, diagnosis, treatment, followup 
     care, monitoring, rehabilitation, and hospice care; and
       ``(B) appropriate care and services which should be 
     provided throughout the continuum of care including 
     palliative care and information on treatment options 
     including information regarding clinical trials.
       ``(b) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this part, other 
     than section 399FF, such sums as may be necessary for each of 
     fiscal years 2006 through 2010.

     ``SEC. 399BB. ENHANCING CANCER CARE THROUGH IMPROVED 
                   NAVIGATION.

       ``(a) Demonstration Projects.--The Secretary shall award 
     competitive grants to eligible entities to develop, 
     implement, and evaluate cancer case management programs to 
     enhance the quality of cancer care through improved access 
     and navigation.
       ``(b) Eligibility.--An entity is eligible to receive a 
     grant under this section if such entity is a hospital; health 
     center; an academic institution; a hospice program; a 
     palliative care program, or a program offering a continuum of 
     hospice care, palliative care, and other appropriate care to 
     children and their families; a State health agency; an Indian 
     Health Service hospital or clinic, Indian tribal health 
     facility, or urban Indian facility; a nonprofit organization; 
     a health plan; a primary care practice-based research network 
     as defined by the Agency for Healthcare Research and Quality; 
     a cancer center; or any other entity determined to be 
     appropriate by the Secretary.
       ``(c) Application.--An eligible entity seeking a grant 
     under this section shall submit an application to the 
     Secretary at such time, in such manner, and containing such 
     information as the Secretary may require, including 
     assurances that the eligible entity will--
       ``(1) target patient populations with an unequal burden of 
     cancer through specific outreach activities;
       ``(2) coordinate culturally competent and appropriate care 
     specified in observance of existing, relevant departmental 
     guidelines, including a special emphasis on underserved 
     populations and how their values and priorities influence 
     screening and treatment decisions;
       ``(3) coordinate with relevant ombudsman programs and other 
     existing coordination and navigation efforts and services, 
     where possible; and
       ``(4) evaluate activities and disseminate findings 
     including findings related to repeated difficulties in 
     accessing navigation.
       ``(d) Use of Funds.--An eligible entity shall use amounts 
     received under a grant under this section to carry out 
     programs in which--
       ``(1) trained individuals (such as representatives from the 
     community, nurses, social workers, cancer survivors, 
     physicians, or patient advocates) are assigned to act as 
     contacts--
       ``(A) within the community; or
       ``(B) within the health care system,
     to facilitate access to quality cancer care and cancer 
     preventive services;
       ``(2) partnerships are created with community organizations 
     (which may include cancer centers, hospitals, health centers, 
     hospice programs, palliative care programs, health care 
     providers, home care, nonprofit organizations, health plans, 
     or other entities determined appropriate by the Secretary) to 
     help facilitate access or to improve the quality of cancer 
     care;
       ``(3) activities are conducted to coordinate cancer care 
     and preventive services and referrals, including referrals to 
     hospice programs, and palliative care programs; or

[[Page S8764]]

       ``(4) the grantee negotiates, mediates, or arbitrates on 
     behalf of the patient with relevant entities to resolve 
     issues that impede access to care.
       ``(e) Models.--Not later than 3 years after the date of 
     enactment of this section, the Secretary shall develop or 
     modify models to improve the navigation of cancer care for 
     grantees under this section. The Secretary shall update such 
     models as may be necessary to ensure that the best cancer 
     case management practices are being utilized.

     ``SEC. 399CC. CANCER CARE COORDINATION.

       ``(a) Demonstration Projects.--The Secretary shall award 
     competitive grants to eligible entities to facilitate the 
     development of a coordinated system to improve the quality of 
     cancer care.
       ``(b) Eligibility.--An entity is eligible to receive a 
     grant under this section if such entity is a hospital; a 
     health center; an academic institution; a hospice program; a 
     palliative care program; a program offering a continuum of 
     hospice care, palliative care, and other appropriate care to 
     children and their families; a State health agency; a 
     nonprofit organization; a health plan; a primary care 
     practice-based research network as defined by the Agency for 
     Healthcare Research and Quality; a cancer center; or any 
     other entity determined to be appropriate by the Secretary.
       ``(c) Application.--An eligible entity desiring a grant 
     under this section shall prepare and submit to the Secretary 
     an application at such time, in such manner, and containing 
     such information as the Secretary may require.
       ``(d) Use of Funds.--An eligible entity shall use amounts 
     received under a grant under this section to improve 
     coordination of the quality of cancer care, by--
       ``(1) creating partnerships and enhancing collaboration 
     with health care providers (which may include cancer centers, 
     hospitals, health centers, hospice programs, health care 
     providers, experts in palliative care, preventive service 
     providers) to improve the provision of quality of cancer 
     care;
       ``(2) developing best practices for the quality of cancer 
     care coordination (with special emphasis provided to those 
     cancers that have low survival rates or individuals with 
     advanced disease), including the development of model 
     systems; and
       ``(3) evaluating overall activities to identify optimal 
     designs and essential components for cancer practices and 
     models to improve the coordination of cancer care services 
     and activities.
       ``(e) Dissemination.--The Secretary shall disseminate 
     findings made as a result of activities conducted under this 
     section to the public in coordination with the Agency for 
     Healthcare Research and Quality, the Centers for Medicare & 
     Medicaid Services, or other appropriate Federal agencies.''.

           TITLE VI--ESTABLISHING PROGRAMS IN PALLIATIVE CARE

     SEC. 601. PROGRAMS TO IMPROVE PALLIATIVE CARE.

       Part R of title III of the Public Health Service Act (as 
     added by section 501), is further amended by adding at the 
     end the following:

     ``SEC. 399DD. PROGRAMS TO IMPROVE PALLIATIVE CARE.

       ``(a) Demonstration Projects.--The Secretary shall award 
     competitive grants to eligible entities to develop, 
     implement, and evaluate model programs for the delivery of 
     palliative care throughout all stages of disease for 
     individuals with cancer (with a special emphasis on children) 
     and their families.
       ``(b) Eligibility.--An entity is eligible to receive a 
     grant under this section if such entity is a hospital; an 
     academic institution; a hospice program; a palliative care 
     program; a program offering a continuum of hospice care, 
     palliative care, and other appropriate care to children and 
     their families; a nonprofit organization; a State health 
     agency; a health center; a cancer center; or any other entity 
     determined to be appropriate by the Secretary.
       ``(c) Application.--An eligible entity desiring a grant 
     under this section shall prepare and submit to the Secretary 
     an application at such time, in such manner, and containing 
     such information as the Secretary may require.
       ``(d) Use of Funds.--An entity shall use amounts received 
     under a grant under this section to--
       ``(1) integrate palliative care with such entities as 
     academic institutions, community organizations, hospice 
     programs, hospitals, cancer patient and survivorship 
     organizations, health care providers, cancer centers, or 
     other entities determined appropriate by the Secretary;
       ``(2) conduct outreach and education activities to 
     encourage the dissemination of evidence-based clinical best 
     practices relating to palliative care;
       ``(3) increase public awareness, including outreach 
     campaigns, particularly to underserved populations;
       ``(4) disseminate evidence-based information to health care 
     providers and individuals with cancer and their families 
     regarding available palliative care programs and services;
       ``(5) provide and evaluate education and training programs 
     in palliative care for health care providers, including--
       ``(A) establishing pilot training programs (including 
     faculty training programs) in medicine, including oncology 
     (including pediatric oncology), family medicine, psychiatry, 
     psychology, pain, nursing, pharmacology, physical therapy, 
     occupational therapy, social work, and other relevant 
     disciplines; or
       ``(B) developing, implementing, and evaluating pilot 
     training programs for the staff of hospices, nursing homes, 
     hospitals, home health agencies, outpatient care clinics, and 
     other entities determined appropriate by the Secretary;
       ``(6) design or implement model palliative care programs 
     for individuals with cancer and their families including 
     improving access to clinical trials, where appropriate;
       ``(7) develop and evaluate pilot programs to address the 
     special needs of children or other underserved populations 
     and their families in palliative care programs;
       ``(8) conduct demonstration projects to enhance or develop 
     online support networks for individuals with cancer and their 
     families, including those networks for individuals who are 
     homebound, and develop other methods to reach underserved 
     cancer patients; or
       ``(9) determine whether strategies developed for palliative 
     care for individuals with cancer and their families would be 
     applicable to individuals with other diseases.
       ``(e) Dissemination.--The Secretary shall disseminate 
     findings made as a result of activities conducted under this 
     section to the public in coordination with the Director of 
     the Agency for Healthcare Research and Quality, the 
     Administrator of the Centers for Medicare & Medicaid 
     Services, and the heads other appropriate Federal 
     agencies.''.

             TITLE VII--ESTABLISHING SURVIVORSHIP PROGRAMS

     SEC. 701. PROGRAMS FOR SURVIVORSHIP.

       Subpart 1 of Part C of title IV of the Public Health 
     Service Act (42 U.S.C. 285 et seq.) (as amended by section 
     101), is further amended by adding at the end the following:

     ``SEC. 417F. PROGRAMS FOR SURVIVORSHIP.

       ``(a) Demonstration Projects.--The Secretary shall conduct 
     and support research regarding the unique health challenges 
     associated with cancer survivorship and carry out 
     demonstration projects to develop and implement post-
     treatment public health programs and services including 
     followup care and monitoring to support and improve the long-
     term quality of life for cancer survivors, including 
     children.
       ``(b) Eligibility.--An entity is eligible to receive a 
     competitive grant under this section if such entity is an 
     academic institution, nonprofit organization, State health 
     agency, cancer center, health center, or other entity 
     determined to be appropriate by the Secretary.
       ``(c) Application.--An entity desiring a grant under this 
     section shall prepare and submit to the Secretary an 
     application at such time, in such manner, and containing such 
     information as the Secretary may require.
       ``(d) Use of Funds.--An entity shall use amounts received 
     under a grant under this section to plan, implement, and 
     evaluate demonstration projects that--
       ``(1) design protocols for followup care, monitoring, and 
     other survivorship programs (including peer support and 
     mentor programs);
       ``(2) increase public awareness about appropriate followup 
     care, monitoring and other survivorship programs (including 
     peer support and mentor programs) by disseminating 
     information to health care providers and survivors and their 
     families; and
       ``(3) support programs to improve the quality of life among 
     cancer survivors, referenced by the quality of cancer care 
     measures developed under section 417E (where appropriate), 
     with particular emphasis on underserved populations, 
     including children.
       ``(e) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section, such 
     sums as may be necessary for each of fiscal years 2006 
     through 2010.''.

     SEC. 702. CANCER CONTROL PROGRAMS.

       Section 412 of the Public Health Service Act (42 U.S.C. 
     285a-1) is amended--
       (1) in the matter preceding paragraph (1), by striking 
     ``cancer and for rehabilitation and counseling respecting 
     cancer.'' and inserting ``cancer and for survivorship, 
     rehabilitation, and counseling respecting cancer.'';
       (2) in paragraph (1)(B), by striking ``and the families of 
     cancer patients'' and inserting ``the families of cancer 
     patients, and cancer survivors''; and
       (3) in paragraph (3), by striking ``diagnosis, and 
     treatment and control of cancer'' and inserting ``diagnosis, 
     treatment, survivorship programs, and control of cancer.''.

               TITLE VIII--PROGRAMS FOR END-OF-LIFE CARE

     SEC. 801. PROGRAMS FOR END-OF-LIFE CARE.

       Part R of title III of the Public Health Service Act (as 
     amended by section 601), is further amended by adding the 
     following:

     ``SEC. 399EE. PROGRAMS FOR END-OF-LIFE CARE.

       ``(a) Demonstration Projects.--The Secretary shall award 
     competitive grants to eligible entities to develop, 
     implement, and evaluate evidence-based programs for the 
     delivery of quality of cancer care during the end-of-life to 
     individuals with cancer (with a special emphasis on children) 
     and their families.
       ``(b) Eligibility.--An entity is eligible to receive a 
     grant under this section if such entity is a hospital; an 
     academic institution; a hospice program; a palliative care 
     program; a program offering a continuum of hospice care, 
     palliative care, and other appropriate

[[Page S8765]]

     care to children and their families; a nonprofit 
     organization; a State health agency; a health center; a 
     cancer center; or any other entity determined to be 
     appropriate by the Secretary.
       ``(c) Application.--An entity desiring a grant under this 
     section shall prepare and submit to the Secretary an 
     application at such time, in such manner, and containing such 
     information as the Secretary may require.
       ``(d) Use of Funds.--An entity shall use amounts received 
     under a grant under this section to--
       ``(1) integrate palliative care or end-of-life care 
     programs with entities including academic institutions, 
     community organizations, hospice programs, hospitals, cancer 
     patient and survivorship organizations, health care 
     providers, cancer centers, or other entities determined 
     appropriate by the Secretary;
       ``(2) conduct outreach and education activities to 
     encourage the dissemination of evidence-based clinical best 
     practices relating to end-of-life care;
       ``(3) increase public awareness, including outreach 
     campaigns, particularly to underserved populations;
       ``(4) disseminate information to health care providers and 
     individuals with cancer and their families regarding 
     available end-of-life programs, including hospice programs;
       ``(5) provide and evaluate education and training in end-
     of-life care for health care providers, including--
       ``(A) establishing pilot training programs (including 
     faculty training programs) in medicine including oncology 
     (including pediatric oncology), family medicine, psychiatry, 
     psychology, pain, nursing, pharmacology and social work, and 
     other disciplines; or
       ``(B) developing, implementing, and evaluating pilot 
     training programs for the staff of hospices, nursing homes, 
     hospitals, home health agencies, outpatient care clinics, and 
     other entities determined appropriate by the Secretary;
       ``(6) design or implement model end-of-life care programs 
     for individuals with cancer and their families including 
     improving access to clinical trials where appropriate;
       ``(7) develop and evaluate pilot programs to address the 
     special needs of children or other underserved populations 
     and their families in end-of-life programs;
       ``(8) integrate palliative care and hospice care activities 
     in the delivery of end-of-life care; or
       ``(9) determine whether strategies developed for end-of-
     life care for individuals with cancer and their families 
     would be applicable to individuals with other diseases.
       ``(e) Dissemination.--The Secretary shall disseminate 
     findings made as a result of activities conducted under this 
     section to the public in coordination with the Director of 
     the Agency for Healthcare Research and Quality, the 
     Administrator of the Centers for Medicare & Medicaid 
     Services, and the heads of other appropriate Federal 
     agencies.''.

                TITLE IX--DEVELOPING TRAINING CURRICULA

     SEC. 901. CURRICULUM DEVELOPMENT.

       Part R of title III of the Public Health Service Act (as 
     amended by section 801), is further amended by adding at the 
     end the following:

     ``SEC. 399FF. CURRICULUM DEVELOPMENT.

       ``(a) In General.--The Secretary shall award competitive 
     grants for the development of curricula for health care 
     provider training regarding the assessment, monitoring, 
     improvement, and delivery of quality of cancer care.
       ``(b) Eligibility.--To be eligible to receive a grant under 
     this section, an entity shall be an academic institution, 
     nonprofit organization, cancer center, health center, medical 
     school, or other entity determined appropriate by the 
     Secretary.
       ``(c) Application.--An entity desiring a grant under this 
     section shall prepare and submit to the Secretary an 
     application at such time, in such manner, and containing such 
     information as the Secretary may require.
       ``(d) Use of Funds.--An entity shall use amounts received 
     under a grant under this subsection to--
       ``(1) evaluate methods of delivery of the quality of cancer 
     care, including palliative care, hospice care, end-of-life 
     care, or cancer survivorship by health care providers;
       ``(2) develop curricula concerning the delivery of quality 
     of cancer care including palliative care, hospice care, end-
     of-life care, or cancer survivorship; and
       ``(3) provide recommendations for training protocols for 
     medical and nursing education, fellowships, and continuing 
     education in quality of cancer care including palliative 
     care, hospice care, survivorship, or end-of-life care for 
     health care providers.
       ``(e) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, such sums as 
     may be necessary for each of fiscal years 2006 through 
     2010.''.

     SEC. 902. CANCER CARE WORKFORCE AND TRANSLATIONAL RESEARCH.

       (a) Cancer Control Programs.--Section 412 of the Public 
     Health Service Act (42 U.S.C. 285a-1) is amended--
       (1) by striking ``The Director of the Institute'' and 
     inserting the following:
       ``(a) In General.--The Director of the Institute'';
       (2) by striking paragraph (2) and inserting the following:
       ``(2) annual and long-term training goals to assure an 
     adequate and diverse cancer care workforce including--
       ``(A) preparing and implementing a plan to provide 
     assistance to health professionals in health professions 
     experiencing the most severe shortages including the 
     provision of grants, scholarships, fellowships, post-doctoral 
     stipends, or loans to eligible individuals to increase the 
     cancer care workforce; and
       ``(B) educating students of health professions and health 
     professionals in--
       ``(i) effective methods for the prevention and early 
     detection of cancer;
       ``(ii) the identification of individuals with a high risk 
     of developing cancer;
       ``(iii) improved methods of patient referral to appropriate 
     centers for early diagnosis and treatment of cancer;
       ``(iv) methods to deliver culturally competent care; and
       ``(v) other appropriate methods for providing quality of 
     cancer care; and''; and
       (3) by adding at the end the following:
       ``(b) Coordination With Existing Programs.--In carrying out 
     the activities under subsection (a)(2), the Director of the 
     Institute shall coordinate with existing programs, including 
     programs at the Health Resources and Services Administration, 
     to prevent duplication.''.
       (b) National Cancer Research and Demonstration Centers.--
     Section 414(b) of the Public Health Service Act (42 U.S.C. 
     285a-3(b)) is amended by striking paragraph (3) and inserting 
     the following:
       ``(3) clinical training (including training for allied 
     health professionals), loan forgiveness or post-doctoral 
     stipends for bench researchers, continuing education for 
     health professionals and allied health professionals, and 
     information programs for the public regarding cancer; and''.
       (c) Translational Cancer Research.--Subpart 1 of part C of 
     title IV of the Public Health Service Act (42 U.S.C. 285 et 
     seq.) is amended by inserting after section 414 the 
     following:

     ``SEC. 414A. TRANSLATIONAL CANCER RESEARCH.

       ``(a) In General.--The Director of the Institute, in 
     collaboration with the Director of the Agency for Healthcare 
     Research and Quality shall enter into cooperative agreements 
     with, and make grants to, public or nonprofit entities to 
     conduct multidisciplinary, translational cancer research.
       ``(b) Use of Funds.--
       ``(1) In general.--The Director of the Institute may use 
     funds provided under this section to establish networks and 
     partnerships to link community cancer providers to programs 
     funded under this section.
       ``(2) Construction of New Facilities.--Funds provided under 
     this section shall not be used for the construction of new 
     facilities.
       ``(c) Strategic Plan.--Not later than October 1, 2006, the 
     Director of the Institute shall develop and implement a 
     strategic plan, in collaboration with entities performing 
     translational research, for identifying, expanding, and 
     disseminating the results of translational cancer research to 
     health care providers.
       ``(d) Duties.--An entity receiving a grant under this 
     section shall--
       ``(1) conduct research with the potential to improve the 
     prevention, diagnosis, and treatment of cancer and to improve 
     the quality of cancer care, including palliation;
       ``(2) conduct clinical research studies on promising cancer 
     treatments including clinical trials; and
       ``(3) evaluate tests, techniques, or technologies in 
     individuals being evaluated for the presence of cancer.
       ``(e) Definition of Translational Cancer Research.--As used 
     in this section, the term `translational cancer research' 
     means scientific laboratory and clinical research and testing 
     necessary to transform scientific or medical discoveries into 
     new approaches, products, or processes that can assist in 
     preventing, diagnosing, or controlling cancer.''
       (d) Authorization of Appropriations.--Section 417B(a) of 
     the Public Health Service Act (42 U.S.C. 285a-8(a)) is 
     amended by striking ``1996'' and inserting ``2010''.

                  TITLE X--BREAST AND CERVICAL CANCER

     SEC. 1001. WAIVERS RELATING TO GRANTS FOR PREVENTIVE HEALTH 
                   MEASURES WITH RESPECT TO BREAST AND CERVICAL 
                   CANCERS.

       (a) In General.--Section 1503 of the Public Health Service 
     Act (42 U.S.C. 300m) is amended by adding at the end the 
     following:
       ``(d) Waiver of Services Requirement on Division of 
     Funds.--
       ``(1) In general.--The Secretary may waive the requirements 
     under paragraphs (1) and (4) of subsection (a) if--
       ``(A)(i) the State involved will use the waiver to leverage 
     private funds to supplement each of the services or 
     activities described in paragraphs (1) and (2) of section 
     1501(a); or
       ``(ii) the application of such requirement would result in 
     a barrier to the enrollment of qualifying women;
       ``(B) the Secretary finds that granting such a waiver to a 
     State will not reduce the number of women in the State that 
     receive each of the services or activities described in 
     paragraphs (1) and (2) of section 1501(a), including making 
     available screening procedures for both breast and cervical 
     cancers; and
       ``(C) the Secretary finds that granting such a waiver to a 
     State will not adversely affect the quality of each of the 
     services or activities described in paragraphs (1) and (2) of 
     section 1501(a).
       ``(2) Duration of waiver.--

[[Page S8766]]

       ``(A) In general.--In granting waivers under paragraph (1), 
     the Secretary--
       ``(i) shall grant such waivers for a period of 2 years; and
       ``(ii) upon request of a State, may extend a waiver for 
     additional 2-year periods in accordance with subparagraph 
     (B).
       ``(B) Additional periods.--The Secretary, upon the request 
     of a State that has received a waiver under paragraph (1), 
     shall, at the end of each 2-year waiver period described in 
     subparagraph (A), review performance under the waiver and may 
     extend the waiver for an additional 2-year period if the 
     Secretary determines that--
       ``(i)(I) without an extension of the waiver, there will be 
     a barrier to the enrollment of qualifying women; or
       ``(II) the State requesting such extended waiver will use 
     the waiver to leverage private funds to supplement each of 
     the services or activities described in paragraphs (1) and 
     (2) of section 1501(a);
       ``(ii) the waiver has not, and will not, reduce the number 
     of women in the State that receive each of the services or 
     activities described in paragraphs (1) and (2) of section 
     1501(a); and
       ``(iii) the waiver has not, and will not, result in lower 
     quality in the State of each of the services or activities 
     described in paragraphs (1) and (2) of section 1501(a).
       ``(3) Reporting requirement.--The Secretary shall include 
     as part of the evaluations and reports required under section 
     1508, the following:
       ``(A) A description of the total amount of dollars 
     leveraged annually from private entities in States receiving 
     a waiver under paragraph (1) and how these amounts were used.
       ``(B) With respect to States receiving a waiver under 
     paragraph (1), a description of the percentage of the grant 
     that is expended on providing each of the services or 
     activities described in paragraphs (1) and (2) and paragraphs 
     (3) through (6) of section 1501(a).
       ``(C) A description of the number of States receiving 
     waivers under paragraph (1) annually.
       ``(D) With respect to States receiving a waiver under 
     paragraph (1), a description of the number of women receiving 
     services under paragraphs (1), (2), and (3) of section 
     1501(a) in programs before and after the granting of such 
     waiver.''.
       (b) Authorization of Appropriations.--Section 1510(a) of 
     the Public Health Service Act (42 U.S.C. 300n-5(a)) is 
     amended by striking ``$50,000,000'' and all that follows 
     through the period, and inserting ``such sums as may be 
     necessary for each of fiscal years 2004 through 2009.''.

                      TITLE XI--COLORECTAL CANCER

     SEC. 1101. PROGRAMS TO IMPROVE COLORECTAL CANCER SCREENING.

       Title XV of the Public Health Service Act (42 U.S.C. 300k 
     et seq.) is amended by adding at the end the following:

     ``SEC. 1511. COLORECTAL CANCER SCREENING DEMONSTRATION 
                   PROJECT.

       ``(a) In General.--The Secretary, acting through the 
     Director of the Centers for Disease Control and Prevention, 
     shall award competitive grants to public and nonprofit 
     private entities to enable such entities to establish 
     demonstration programs pursuant to the general authority of 
     title III to carry out colorectal screening activities 
     including--
       ``(1) screening asymptomatic individuals as determined by 
     the Secretary in accordance with category A or B 
     recommendation rating of the U.S. Preventive Service Task 
     Force or as otherwise determined by the Secretary;
       ``(2) providing appropriate case management and referrals 
     for medical treatment of individuals screened pursuant to 
     this section;
       ``(3) establishing activities to improve the education, 
     training, and skills of health professionals (including 
     allied health professionals) in the detection and control of 
     colorectal cancer, as a part of their participation in the 
     screening program established under the grant;
       ``(4) evaluating the programs under this section through 
     appropriate surveillance or program monitoring activities;
       ``(5) developing and disseminating findings derived through 
     such evaluations and outcomes data collection; and
       ``(6) promoting the benefits of and participation in the 
     colorectal cancer screening program established under the 
     grant.
       ``(b) Requirements.--
       ``(1) Priority.--To be eligible for a grant under 
     subsection (a), an entity shall agree with respect to 
     activities and services under the grant to target low-
     income--
       ``(A) individuals who are at least 50 years of age; or
       ``(B) individuals at high risk for colorectal cancer (as 
     defined in section 1861(pp)(2) of the Social Security Act (42 
     U.S.C. 1395x(pp)(2))).
       ``(2) Relationship to items and services under other 
     programs.--To be eligible for a grant under subsection (a), 
     an entity shall agree that grant funds will not be expended 
     to make payments 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--
       ``(A) under any State compensation program, under an 
     insurance policy, or under any Federal or State health 
     benefits program; or
       ``(B) by an entity that provides health service on a 
     prepaid basis.
       ``(3) Records and audits.--To be eligible for a grant under 
     subsection (a), an entity shall agree that the entity will--
       ``(A) establish such fiscal control and fund accounting 
     procedures as may be necessary to ensure proper disbursal of, 
     and accounting for, amounts received under this section; and
       ``(B) provide agreed upon annual reports to the Secretary 
     or the Comptroller of the United States for the purposes of 
     auditing the expenditures by the entity.
       ``(4) Reports.--To be eligible for a grant under subsection 
     (a), an entity shall agree to submit to the Secretary such 
     reports as the Secretary determines appropriate.
       ``(c) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, such sums as 
     may be necessary for each of fiscal years 2005 through 
     2009.''.

                     TITLE XII--CONDUCTING REPORTS

     SEC. 1201. STUDIES AND REPORTS BY THE INSTITUTE OF MEDICINE.

       (a) Contract.--The Secretary shall enter into a contract 
     with the Institute of Medicine to--
       (1) evaluate Federal and State activities relating to 
     comprehensive cancer control programs and activities;
       (2) evaluate the quality of cancer care (including 
     palliative care, end-of-life care, and survivorship) that 
     medicare and medicaid beneficiaries receive and the extent to 
     which medicare and medicaid coverage and reimbursement 
     policies affect access to quality cancer care;
       (3) evaluate data from the Centers for Medicare & Medicaid 
     Services and other agencies on volume-outcome relationships;
       (4) evaluate access to clinical trials and the relationship 
     of such access to the quality of cancer care, especially with 
     respect to health disparity populations; and
       (5) assess existing gaps in and impediments to the quality 
     of cancer care, including gaps in data, research and 
     translation, seamless patient care and navigation, palliative 
     care, and care provided to underserved populations.
       (b) Reports.--
       (1) In general.--Not later than 4 years after the date of 
     enactment of this Act, the Institute of Medicine shall submit 
     to the Secretary of Health and Human Services a report 
     containing information on the evaluation conducted under 
     paragraphs (1) through (5) of subsection (a), including data 
     collected at the State level through contracts with 
     appropriate organizations as designated by the Institute of 
     Medicine.
       (2) 8 years.--Not later than 8 years after the date of 
     enactment of this Act, the Institute of Medicine shall submit 
     to the Secretary of Health and Human Services a report 
     containing information and recommendations on the areas 
     described in subsection (a), including data collected from 
     relevant demonstration projects.
       (3) Reports.--The Secretary of Health and Human Services 
     shall submit the reports described in paragraphs (1) and (2) 
     to the relevant committees of Congress.
       (c) Definitions.--
       (1) Palliative care; quality of cancer care.--The terms 
     `palliative care' and `quality of cancer care' have the 
     meanings given such terms in section 399AA of the Public 
     Health Service Act.
       (2) Comprehensive cancer control program.--The term 
     `comprehensive cancer control program' has the meaning given 
     such term in section 320B of the Public Health Service Act.
       (3) Health disparity population and health disparities 
     research.--The terms ``health disparity population'' and 
     ``health disparities research'' have the meanings given such 
     terms in section 399AA of the Public Health Service Act.
       (d) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, such sums as 
     may be necessary for each of fiscal years 2006 through 2010.

  Mr. KENNEDY. Mr. President, it is a privilege to join my colleague 
Senator Bill Frist in introducing this bipartisan legislation to 
improve the prevention and treatment of cancer. The Quality of Care for 
Individuals with Cancer Act is a result of the combined efforts of many 
in the cancer community, including patients, families, cancer 
survivors, and health providers. Its goal is to see that as many of our 
fellow citizens as possible are able to obtain state-of-the-art cancer 
care.
  The Nation's continuing investment in medical research in the past 
decade has led to many new and innovative options in cancer treatment 
and prevention. We all want to believe that when a loved one or someone 
we know is diagnosed with cancer, they will benefit from the latest and 
most effective treatments. Unfortunately, that is often not the case.
  Many cancer patients receive the wrong care, too little care, or even 
too much care. Colon cancer is 85 percent curable if it is detected 
early through screening. Yet today less than half of all Americans who 
should be screened for colon cancer are actually screened. If we do not 
act to correct these problems, over a quarter of a million parents, 
sons and daughters, will die from this curable cancer in the next 5 
years.
  Much more can be done to extend the reach of high-quality cancer care 
and

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reduce this burden of unnecessary suffering and premature death. New 
discoveries of science can be brought much more quickly from the 
research laboratory to the bedside of the patient and to the practice 
of medicine in all communities.
  Our bill will help assure that the care of cancer patients is 
coordinated from diagnosis through successful treatment. The quality of 
end of life care will be significantly improved. Needed programs will 
be established to meet the ongoing needs of cancer survivors and their 
families.
  Health care provider training will make the latest in cancer care 
available through improved education and networking. Patients will have 
access to providers who know how to deliver the most effective cancer 
treatment at the right time and in the right way.
  Today, the best in medical research is too often not available to 
treat and cure many different types of cancer, especially leukemia, 
breast cancer, and prostate cancer. The treatments will vary for each 
patient, but the standard of excellence in cancer care should be widely 
available to all. Enactment of this legislation will bring that day 
closer, and I look forward to its enactment, its implementation, and 
the benefits it will bring to so many of our fellow citizens in the 
years ahead.
                                 ______